Something that struck me reading this, which I’m sure others have noted before, is that people who “trust the science” on sex education know that abstinence-only doesn’t work. Many teens will have sex even if you tell them not to, and that what you *can* do is encourage and provide education about safe sex practices while reinforcing that the safest practice is abstinence.
In my experience, well-educated liberals tend to view abstinence-only-in-sex-education advocates as being willfully blind to how humans behave in the real world, and as valuing idealogical purity over achieving the best outcomes.
I tried going without at Wal-Mart a couple weeks ago and the greeter offered me one. She's been there almost every week the whole damn pandemic, so I smiled at her and put it on.
I've noticed a general trend that people like to say "X doesn't work" when the reality is that "X is not 100% effective". But sometimes, less than 100% is still worth pursuing, and sometimes even an X that is less effective than alternative Y is worth pursuing because some people who can't be convinced to do Y might try X.
It's even more amazing when you consider that senior public health people must have got their start in the late 80s and early 90s, when implementing useful harm reduction strategies around AIDS was a really big deal. Did they all forget how that's supposed to work?
When we finally got hold of masks here and it was mandatory to wear them, I was waiting in line at a butcher shop. A guy stepped out of the shop and then put on his mask. So I asked him when he normally put on his condom.
I wore masks back in Feb of 2020 because it was obvious that CDC and “experts” were lying or dumb.
I stopped wearing masks as soon as I was fully vaccinated back in March, because it was obvious that science is awesome and experts were lying it dumb about the need to continue.
Also… Florida did better than California because they didn’t keep people inside as much.
California probably killed a non-zero number of people by closing beaches and parks. (Then again, so did every place that restricted people from the outdoors) resulting in people spending more time inside.
I’d like to see more analysis on why people have been so resistive to Covid restrictions and advice. I have a theory.
600K dead. 339M population. Covid killed 0.2% of population. That’s 1 out of every 500 people. Sounds bad. Except that number wasn’t distributed randomly. It was overwhelmingly senior citizens.
One of the artifacts of American culture of the nuclear family vs extended family living arrangements is the elderly are a much smaller percentage of any given person’s acquaintances. We know our grandparents, but after that… most of our acquaintances are people within the same broad age range of us, or younger. We are more likely to know our kids friend than our grandparents friends.
Since I travel for work. Multiple job sites a month. Always with different people, I have started asking people if they know anyone who has died from Covid. I ask strangers on planes. Coworkers. Etc…. And by know, I mean personally. Not friend of friend.
I’ve asked maybe 100-200 people. Only two people have said yes. One was their father in Venezuela. The other was their Grandmother in the US.
I don’t even know anyone who has been in the hospital. I know of people, but don’t know them in any recurring way.
Now, yes… a lot of people have died. I have taken the pandemic seriously from the beginning (I’m naturally risk adverse), but I get why there is a lot of skepticism about the seriousness of Covid.
The media constantly bombarded us with numbers, but there was very very few “faces”. I remember a half dozen cases where there was a young nurse, or a 40-year old dad, but considering there was 600K deaths, the media did a very poor job of putting a human face on. And the reason is simple… the vast majority of deaths were elderly or medically fragile, likely to be obese. People who just don’t garner the same sort of “clicks” as a young nurse.
The simple fact is that the actual disease of Covid didn’t have as much of impact on people’s personal lives as the restrictions did.
When you have this imbalance from daily lives experience and media/experts narrative, it is no surprise that people become skeptical.
I’m not sure how we could of done better as a country. Truthfully given the learning curve and the awesomeness of developing effective vaccines, and having Trump in office, I think on the whole we did pretty good. Shit would of been a lot worse even a decade ago.
Anyway… that’s my dumb take.
Typing on my phone. Forgive any grammatical errors. On my way to Pittsburg for a week and a half. Time to recertify in my job.
Closing the beaches and playgrounds when a large segment of your population lives in crowded housing can actually increase spread within households. But hey, at least people aren’t enjoying themselves in public
The lesson will be complicated, though. The next pandemic probably won't be the same as this one, so we won't simply be able to follow the same mitigation strategies that worked this time, and abandon those that didn't. Instead, we'll need to develop a set of principles that will be flexible enough for various possible fact situations.
I think it’s safe to say, that the next pandemic will more likely than not be some sort of airborne spread virus.
It’s not only Covid that they have learned more, it’s also regular flu.
There is such an interesting story or podcast about how scientists have misinterpreted something about the size of the virus and how far it spreads.
Some grad student tracked it back to some paper from I don’t know maybe the 30s or 40s. And it was basically a misquote, which just continually got perpetuated. Sort of like the one in 10 people is gay thing. (among millennials that number is actually strangely accurate though). Folk wisdom of medical science, that never gets verified. It’s just assumed to be fact.
I've been waiting for someone to explicitly say "no one cares about COVID because it's actually very unusual to personally know someone who's died from it". Personally I took it seriously despite not even knowing anyone who knows someone who died from it. But that was more because of concerns about "long COVID" and just not feeling like my life had the bandwidth for a multi-week unplanned vacation to get through the flu.
The way to do better as a country would be to have actually followed the science:
- ventilation ventilation ventilation. No one did much of anything about ventilation
- open up new venues of activity outdoors, rather than closing existing ones
- rapid widespread testing so that people could gather *safely*. Facilitate people getting tested proactively before gathering, rather than reactively after a gathering/traveling/when they have symptoms
The upshot of all this is that you need to clear out a lot of the literal garbage foisted on us by the CDC ("wash your hands without touching the faucet with your hands themselves") state/local government (hygiene theater on NYC subways) and the media in particular the NYT, in particular the reporter Matt is calling out here ("even if you're tested YOU'RE STILL NOT SAFE, so really the only appropriate course of action is to cocoon yourself for the next 18 months").
And finally as Matt has noted several times, probably the only way to clear out the garbage and do the high value stuff like widespread testing, ventilation, etc. is with a federal response - both in pushing the CDC to admit that they screwed up with the surfaces stuff in February, and in providing the financing for eg schools to upgrade their ventilation systems. But Trump is first and foremost incompetent, and his venality comes in at a distant second, so we got inertia.
Anyway TL;DR I approve of your take, I think you're 100% correct and a lot of people should know better.
One other thing. Even people that did know people who died, it was likely to have been someone elderly, that well they sort of knew would die at some point in the not too distant future. Another thing that sounds heartless to say, but is true.
I am really curious about whether we are going to have a mortality compression artifact. It is possible, that in the next 2 to 3 years, we see a lower the normal mortality rate. The only complicated factor is long-haul Covid. However, I confess that I am a little bit skeptical about the severity of long-haul Covid. Some unknown percentage of long haulers, our having psycho somatic symptoms. This is pretty obvious when they say that they recovered when they had the vaccine. Since there is no medical mechanism for why this would happen. Also the demographics of long-haul Covid skew heavily female under 50. I’ve read whispers in the scientific circle about this, but it’s also something that is not possible to say out loud.
3. There is no easily explainable mechanism on why women would have this disproportional amount of long term symptoms. Attempts have been made to say its because women have stronger immune systems, and its an overreaction by immune symptoms, this is just an attempt to explain.
So while not a direct correlation, there is an associative correlation.
Similar to chronic fatigue syndrome, coincidentally (or not).
I do know someone having various intermittent issues (breathing for a while, then neurological) over a year after having semi-serious COVID. He's a pretty rational guy and his wife is a doctor, so he's not making it up, but there's no way to know if it's related or to what degree.
I definitely believe there are some long haul Covid survivors. Your friend is a male, which is less likely to have somatic symptoms. The fact that he had a serious documented case of Covid, which is known to cause lung damage, also makes sense.
However, a pretty significant portion of “long haulers “have no documented cases of Covid, turned up negative on antibody test, and definitely did not have any symptoms or serious symptoms of Covid, yet still say they have serious ailments.
My theory sort of dawned on me towards the end of last summer. But it’s like the secret you don’t want to see out loud. That’s when I just started informally asking people. And then when I kept getting no responses, I started looking at the numbers closely, and they mathematically sort of corresponded with my findings.
To tell the truth, I suspect it was an open secret among epidemiologists. But one of those, agree to not speak out loud secrets, because we don’t want people to get lax.
Here is another open secret. Despite people talking about how traumatic the pandemic and lockdown has been. Many people loved it. Honest truth. The month that me and the wife were at home, was awesome. The three months she was out on unemployment getting paid for nothing, was awesome.
I know it probably sucked for some people. People who lived alone. People without close family. But there’s a lot of people that liked it. Enjoyed the forced vacation.
This is another one of those things that people can’t say out loud, because it comes across as callous, but is true.
I'm vaccinated. I know that my wearing a mask isn't really necessary to prevent me from spreading COVID. I continue to wear a mask in stores and other public places where people may not be aware that I am vaccinated because it keeps people who can't effectively get vaccinated from having to worry that I am not, and hopefully encourages other people, including those who are not yet effectively vaccinated, to keep wearing masks.
I think this is well intentioned and probably does help people some. I’m kind of doing the opposite: as I’m vaccinated, I’m going maskless wherever it’s allowed (I’m in LA so that’s not all that many places), with the thought that I’m helping to normalize masklessness. My own bet (based just on intuition I guess) is that there are more vaccinated people who would like to go maskless but don’t want to be the only ones than there are people who can’t get vaccinated and are afraid of maskless people in case they aren’t vaccinated. So as I see it I’m helping people feel like they can take off their masks without being some kind of iconoclast.
I'm so fascinated about how different social behaviors seem to have been. Up until December I was staying in Bryan/College Station, and basically only leaving the house for walks and bike rides around the neighborhood. When I spent a week at an Airbnb in Austin working remotely, I realized I needed to develop a habit of carrying a mask when I left the house. But since January I've been living temporarily in Austin, so I've developed that habit. People generally seem to have been taking things "very seriously" here, but by Texas standards that means wearing a mask while waiting to get seated outdoors at a restaurant, not wearing a mask while actually outdoors (except on the very most crowded part of the bike/run trail). I think having a blue population in a red state may have been the best balance of pandemic protocols. (Though also, there were obviously people eating indoors in all these restaurants for months, and I didn't know what it was like to be them, even though I could infer their existence from the sounds I heard through the doors.)
Austin sounds exactly like where I live about a 1000 miles N/NE of Texas. Definitely not a red state here but outside of the coastal liberal bubble.
It would be interesting to hear from people in the states that were actually meaningfully more successful than the median: Hawaii, Alaska, Oregon, Utah, Maine, Vermont, Washington and hear more about what their policies were.
In the end, though, I suspect local state policies are only about 10-20% of the equation. Weather, density, housing and working conditions and the general health and age profile are probably the dominant factors. Masks, indoor dining and school closings are highly visible and drive emotions but explain a small part of the variance at the end of the day.
Seems uncharitable. The majority of people I know who are keeping their masks on are trying to put other people at ease. Misguided perhaps but hardly denialism.
But the other people either are vaccinated in which case they don’t need to worry, or unvaccinated in which case it’s a choice, and aren’t worried anyway.
Either way. The science is clear. Vaccinations work and are safe and eliminate the need for wearing masks.
So any behavior that is outside this is science denialism, whether it’s out of concern or social signaling.
Also… wearing masks hinders human interaction and communication. Smiling is a way to display trust and acceptance in human beings. So wearing masks has social consequences.
The fact that you cite the social consequences of masks as relevant (which I agree, they are) kind of weakens your position that wearing a mask to put other people at ease is just pure denialism. We do things all the time that are not strictly necessary but help reassure others. Someone with a well-trained dog might still keep it on a leash. A man (sorry for this crass example) who has had a vasectomy and has no STDs will still wear a condom for sex if his partner prefers. Now, as I’ve said I think people should feel free to go maskless—I’m doing it myself—and in the long term that will lead to people being more at ease with masklessness. But the idea that wanting not to alarm others is “denialism” just flies in the face of social convention and courtesy.
Also, you mentioned that the unvaccinated are so by choice. True in most cases, but a lot of blue staters I know have a lot of concern for those who can’t get vaccinated due to immunodeficiency. To be clear, I think the immunocompromised have come to occupy a greatly disproportionate place in this discourse—to hear people talk about it you would think that every tenth person can’t get vaccinated—and I suppose you could call that a sort of denialism. But it’s hard for me to judge people all that harshly for being concerned for unfortunate, at-risk people.
I confess my passion on this subject is biased on how much I hate masks. My masks always feel damp and irritate my skin. My wife can wear a mask all day with no issues.
Your point about putting people at-ease is why I where a mask. I don't in situations where I can put people at ease that I'm vaccinated. When friends come over, we confirm everyone is vaccinated and take off our masks. At the store, that doesn't really work.
W/respect to immunodeficient people, have you seen a good stat on this? The best I have is that, out of the 10 people in my wife's singing group, one had to drop out b/c the immunosuppressant she takes for MS have prevented her from developing antibodies. At least in that case, it is every tenth person (although this obviously is anecdata).
It has been frustrating to me that people don't acknowledge that children under 12 cannot get the vaccine. And yes, I understand the much lower risk to children; but in so many discussions invovling what to do about restrictions, under 12 are not mentioned. Like all unvaccinated people, children are still vectors for Covid. I'm not advocating for a position here, I'm just saying please acknowledge this as part of dicussions. Hopefully September will change this.
I think we really have underestimated how much masks hinder communication. Many people perceive a masked face as more threatening than an unmasked face. And this is a big problem for people with dementia who in many cases have seen very few unmasked faces in the past year.
But we don’t need to socialize with the vast majority of people we come across. To be clear, I support masklessness and want to get there sooner (see my earlier comment) but I think judging people for being at whatever comfort level they’re at, or for trying to put other people at ease, is useless and counterproductive.
I don't disagree with that. I'm just focusing in on the part where people think they are putting others at ease and questioning whether that's actually the impact. I know for me, personally, it does quite the opposite, it makes me very uneasy. Mainly because of the horrible political, social, and sometimes racial tensions covid has caused or exacerbated. I think mask-wearing by the vaccinated, at this point, feeds into those tensions without doing anything tangible for public health.
It's just my 2 cents but I don't think I'm the only person who feels like arguments for trusting the democrats are undermined when masking rules and behavior make no sense.
It doesn't make socializing awkward, because, if you are at the point of socializing, you can confirm that everyone is vaccinated and, if so, take off the mask.
I meant socializing much more loosely than that. I'm thinking about ordering food and being misunderstood, or watching my kid play in the playground and so sometimes interacting with other parents or kids. Or random interactions on the street or in a hotel. Things like that are more awkward. I don't know anybody who's wearing the mask in private gatherings.
I am continually amazed by the people who continue to wear masks outdoors, even in the sun. I have an urge to stop them and say, “Dude, there’s a CVS right down the street giving out vaccinations.”
In Asia people wear masks to help with allergies. I know a few people who have said that wearing masks outdoors has really helped their allergies and they will continue the practice after the pandemic.
Whenever the lawnmowers are out in force these days I'm thankful that I always have a mask in my pocket. I put it on when I enter a business, or a home, but usually take it off a moment later if it's clear it's not needed, but for the lawnmowers it's always helpful.
You shouldn’t do that! They aren’t hurting you—yes, social impacts, whatever, but you don’t need to exchange smiles with everyone on the street. Just live and let live!
It's interesting to hear that because when I see people with masks on at this point I immediately wonder "what are they thinking?" Are they anti-vax? Are they trying to show some kind of loyalty to Team Blue? Is there a rule in this store I'm not aware of? Are they going to judge me for not wearing one? Do they not understand that vaccinations work really well? When does this end? It raises all those questions and ultimately leaves me feeling frustrated and resentful towards them.
>>>California probably killed a non-zero number of people by closing beaches and parks.>>>
I spent Feb-June 2020 in the Bay Area. I visited the park in my town (Menlo Park) virtually every day, and went hiking frequently in county (state?) parks in the Santa Cruz Mountains. I also visited the beach multiple times. I had zero access problems.
I don't disagree it's stupid to close parks/beaches. But that's not what I was seeing.
You wrote, "Also… Florida did better than California because they didn’t keep people inside as much." Matt's article says "On a per-capita basis, Florida had 8% more deaths [than CA]"
So I'm wondering if you're using a different metric than deaths per capita or disagree with Matt's numbers?
To add to your sample, my grandmother died of COVID in FL. My understanding is she got it from her in-home caretaker who got it from a young family member who attended indoor social gatherings during lockdown.
I am sorry about your grandmother. Many people were especially callous about the risk they presented to other people.
Florida did better when taking into account age adjusted risk.
Since Covid outcomes was overwhelmingly based on age. You have to ask… were you safer as a 60-year old in Florida or California? (The answer is Florida). This is not to discount what happened in your family.
Just that Florida’s spent more time outside than places that had more restrictive lockdowns.
Risk assessment and trade offs are the biggest loser in the pandemic.
It’s become almost sacrilege to say, but everything in life is a risk.
By driving to work, I risk hitting a pedestrian. The pedestrian risks being hit by a car by leaving the house.
Now obviously there’s really risks and restrictions trade offs. I’m not sure where to draw the line.
I had no choice. My job continued during pandemic. I traveled.
Now I don’t have much sympathy for people who don’t get vaccinated, but they don’t present a risk to me as someone who is vaccinated.
I also am very worried about the long term costs of the pandemic. For instance schools. There is a very real chance we hamstring a whole generation of kids. Increased inequality.
I think there are serious questions about whether some of the restrictions were worth it.
Ah, this makes sense (to save anyone a click - the age-adjusted mortality rate is lower in FL than in CA) and I think that's a good point. I think Florida did a lot right (their treatment of nursing homes versus NY) and not keeping people indoors.
CA is above the national average for vaccinations and FL is below - so we'll see if FL is able to continue having fewer deaths per capita going forward but it's probably not that far apart (72% vs 62% with one dose) to make much difference.
Interesting I've been shocked as parties and BBQs and such have started up again how many people have tales of being very sick, hospitalized, still suffering breathing problems months later, etc. And these are people in their 30s and 40s.
I wonder if it’s a result of our social circles. I’m assuming that you live in NYC and have a more liberal social base.
Perhaps my more conservative associates play it down and perhaps more liberal people play it up.
The numbers say that people in their 30s or 40s would have an extremely low chance of being hospitalized. (3.9%). Given that infection rate was really about 20% of population. This means that only about 1 out of 100 people between the age of 30-39 would of been hospitalized.
Even if 100% of NYC had been hospitalized, only 1 out of 25 people this age would have been hospitalized.
For ongoing symptoms the rate was 31% of Covid sufferers (sel-reported). This means that with a 20% infection rate, 6 out of 100 people would have ongoing symptoms.
At some point you have to ask why everyone you know says they won in Vegas, yet Vegas is still paying their electricity bill.
Note: my estimates don’t take into account that hospitalization was centered those who were obese and had other commodities. Curious as to whether those who say they were hospitalized were more likely to be obese or have other medical conditions.
6 out of 100 is 1 in 16. If you have 30 people at a party roughly two of them would have ongoing symptoms. I would add that at least with my small sample, the people with ongoing symptoms had a really rough experience even if they didn't end up being admitted to the hospital. As an example laying in bed all night thinking...if it gets any harder to breath then I'm going to the ER. There are also those who had the "if it gets harder to breath I'm going to the ER" experience who didn't end up needing to go the ER and don't have ongoing symptoms. They were just really sick.
One strange part of this is that one BBQ was at my antivax Trump loving brother in law's lake house in NH. The weird part of it is that he's convinced COVID is no big deal and he doesn't need to get vaccinated despite his 30 something best friend almost dying of it and his neighbor (late 40s maybe?) having a really bad time and still having breathing problems months later. People are weird.
On a side not. I love this substack. I suspect we might have different views. Then again maybe not. But discussion is so civilized here and I learn a lot.
I’m a weird combination of skeptic and precaution taker. I suspect some parts of Covid were overblown in media. But I also believed in masks and vaccines.
I don’t know that many people who died but my life was so turned upside down for so long it’s staggering to me. I really can’t understate how constant the disruption was from March 2020 to the end of school it was an endless string of muddling through without either safety or normalcy.
One thing NPR has done well is reporting on the lives of COVID victims by. It may have not been strictly statistically representative, but it gave a good sense of the spectrum of those affected.
I’m not so sure. NPR listeners are overall progressive. So their balance of stories may have skewed people’s risk evaluations. My take is that progressives overestimated personal risk whereas Conservatives underestimated it. Both were counterproductive.
Then again, perhaps my assessment is skewed or wrong as well.
The problem is that people overly dichotomize risk; the anecdata that the NPR reports provided anecdata that temporized the lack of firsthand acquaintance with people getting sick who were heuristically treating the problem as negligible. Progressives who overestimated risk had already maximized their fears so the NPR reporting could do little to increase that.
This is a really interesting perspective. Your anecdote about asking so many people whether they knew someone who died of covid and finding so few is surprising but, by the numbers, makes perfect sense. I unfortunately lost 2 family members and about a dozen patients. Thinking about the way the experience of the worst outcomes have been distributed, I suppose there is cause to be more thankful so many have been as diligent about masking and other measures. Your take is hopeful in yeah way and I appreciate it. Also, enjoy the Burgh. I think it’s a great place to visit.
I suspect that a few people know many people who died. For instance my grandmothers boyfriend died, as well as many of her friends. She survived it at the age of 92.
It’s just the distribution of social circles. And also a sad commentary on how Americans are disconnected from our senior citizens.
Also. Assuming you are a medical person, thank you for all you did. My ex-wife is a nurse (we are still friends) and her experience was a lot more challenging than mine.
Something about covid just seems to have broken the brains of a lot of blue state liberals. How do you ever convince yourself it would be a good idea for the government to mislead the public about the effectiveness of public health interventions in order to put pressure on recalcitrant governors?
Public health people should tell the truth about public health matters. Governors who ignore or subvert guidance should be judged by their electorates. Why does this even need spelling out?
I'm so sick of the people who think it's the government's job to play jedi mind tricks to manipulate the population into doing things. It's the government's job to provide information and reasonable guidance informed by that information.
So instead of saying, "Masks only work for doctors; regular schmucks like you can't possible use them correctly," they should have said, "Masks are useful, but doctors and first responders need them more than you do, so please don't horde them." Instead of saying "COVID is a serious risk for your average 20-year-old, so get vaccinated to save yourself", say "The risk of COVID to your average 20-year-old isn't very big, but please take one for the team and get vaccinated to help people at higher risk than you."
The people who advocate for these jedi mind tricks tend to also be the people who wonder why the people who don't fall for these jedi mind tricks have such low faith in government. Just treat people like adults. If you want to change people's mind, hire Frank Luntz to manipulate people like adults https://debeaumont.org/news/2021/focus-group-vaccines-republicans/ (Not a sentence I expected to type.)
My observation has been that academic schools of public health are extremely paternalistic, and tend to attract students who are both earnest and highly controlling.
Yes, this is a good point. I am a graduate student in public health and the default position here for any given issue is that the government should dictate what people can do.
It’s worth noting that “The people who advocate for these jedi mind tricks tend to also be the people who wonder why the people who don't fall for these jedi mind tricks have such low faith in government” is natural when you think about it - they’re just projecting their own credulity downward.
This is exactly right. This idea that you can turn around people who are skeptical of government officials by shading the truth is nuts. You just provide ammunition for the people who want to undermine the message. Sticking to the facts is a much better strategy.
Obviously I think this whole thing was glorious, but I think you (and just about everyone) is being too credulous with the public health people saying “oh of course we didn’t think masks were useless, haha we knew the whole time, we were just trying to manipulate people”. As Zeynep Tufekci has written (https://www.nytimes.com/2021/05/07/opinion/coronavirus-airborne-transmission.html), it wasn’t obvious to the “experts” that the virus was airborne for quite a while, and they were also pushing ridiculous hand-washing techniques at least through June.
Isn’t it at least as likely that they had no idea that masks were useful, that they were relying on (completely irrelevant) studies showing improper mask use is worse than no mask use with surface-transmissible viruses, and that they’re only coming up with this “we wanted to protect our Healthcare Heroes (tm)” rationale after the fact?
And WHO didn't change their recommendation on masks until June, 2020. Fauci/CDC did so in early April. Pretty clearly the science of all this was in flux for months, and the public record reflects this.
As a scientist, what irks me is now the public wants the government to dial up "the scientists" and get "the answer". We do what we do and give a detailed, nuanced answer based on the current best understanding. And when that understanding---of a novel coronavirus a few months after it was discovered---changes, suddenly "the scientists" were wrong about everything.
Same with the lab-leak hypothesis, where journalists went and asked "the scientists" when the consensus was essentially "default hypothesis is zoological, but cannot rule out lab leak", Team Red reported "scientists confirm China unleashed bio-weapon" while Team Blue reported "scientists rule out lab leak".
I mainly stuck to reading about everything in scientific journals and ignored the media, because I could, and was blown away when the deluge of "suck it, people who don't share my political views" stories came out about the lab leak and now---again---about masks.
I agree with all of that but under the surface here is some variation in rigor between (say) chemistry and epidemiology that gets obscured by the label “science”. At this point it’s clear that epidemiology as practiced has more in common with folk wisdom than is readily apparent when labeled “science”.
I happen to be a (Physical) Chemist and I could not agree more. Much of what we call "science" these days is, in practice, applied statistics. I'm not knocking other disciplines and I'm saying that epidemiology is not a science, but it is too easy to hide behind p-values and declare confirmation bias rigorous. And then to get your back up on Twitter when someone questions your fast-tracked-to-publication that made it into Nature because of the salience of the pandemic. Oh, and don't get me started on the abuse and misunderstanding of epidemiological models.
The literature that I was reading was more along the lines of modeling aerosol dispersion using fluidic dynamics, evaluating the pressure drop across various mask materials, measuring the longevity of fomites, etc. My wife commented several times that we always seemed to be ahead of the RIVM (the Dutch version of the CDC) when they rolled out new guidance. On that note, I appreciated how the RIVM held the line on school closures, citing the lack of evidence that keeping them open was dangerous in the face of an angry and panicked public.
Yeah this is exactly what I have in mind. What seems to be missing is a public understanding of the difference between a science that builds a theory vs. a science that confirms/debunks a bunch of disjoint hypotheses.
As a non-scientist, I was frustrated by scientists basically saying “shut up until there are peer review articles.”. Even in March of 2020, anyone who had studied what happened on the Diamond Princess and knew a little about other coronaviruses would have been fairly confident that 1) many infections had few or no symptoms and 2) the primary route of transmission was airborne.
I was deeply frustrated at some of the things people said in their capacity as scientists, like completely debasing themselves by signing these letters proclaiming things to be true that were not the scientific consensus. I'm not going to tell anyone to shut up, but at the start of the pandemic, I read papers from previous outbreaks (e.g., SARS) and it ended up mapping on to COVID pretty well; generally, I mean, about transmission, mask effectiveness, that kind of thing.
The lack of understanding of exactly how the virus spreads was definitely one component.
But I am pretty sure the "save PPE for medical workers" rationale was also on their minds. After all, they did consider masks essential for medical workers, so it is not like they thought they were ineffective.
Moreover, isn't the rationale *more* damning to them? That one involves deliberate lying.
So the way to explain their consideration that masks were “essential” is to remember that hospitals were never going to tell doctors that they don’t need masks for a million and a half different self-interested reasons. Consequently, public health officials showing up and saying that masks are completely irrelevant even for Healthcare Heroes was going to spark a lot more backlash. So the way to hedge was to say masks provide >=0 utility for “trained professionals” but <=0 utility for savages. But in their minds masks had exactly 0 utility even for pros.
Now I agree that it’s not obvious what’s correct, but I don’t view public health people’s regard for masks for HC workers as evidence one way or the other. I think the more compelling evidence is that all these public health people were hanging out at conferences about the importance of hand washing without masks.
I think it's actually a combination of the two. The conventional understanding (at least as I was taught pre-pandemic) is that surgical masks are best as source control. They're primarily effective in stopping a sick person from spreading particles and only have marginal benefit when worn by the healthy person interacting with them. This means that the effectiveness of masking primarily depends on the number of sick people present and at the time we were only beginning to appreciate the prevalence of asymptomatic infection. So in the face of shortages, masking in hospitals is much more efficient than masking healthy people even if it has non-zero benefits. I remember listening to an April 2020 JAMA podcast where Dr. Fauci said basically that. Mask wearing might have some individual benefit but because most people aren't around a lot of COVID patients it would be small and on balance saving PPE for hospitals would do much more good.
[lack of edit button] personally I think deliberately lying is less damning because they’re then lying for the greater good. In the “they’re morons” version, they’re claiming the mantle of “science” while practicing something more akin to health marketing.
I’m very confused. Weren’t doctors and nurses treating Covid patients wearing N95 masks from the beginning? Was this just an issue of recognizing asymptomatic transmission?
They believed it was mainly small particles unless aerosol generating procedures were used. Given the proximity and context length it still made sense to wear N95 masks based on that alone though.
I've struggled trying find it again, but there was a tweet from an epidemiologist at a conference circa Feb. 2020 of a picture of something like 50-100 people in a room, most without masks, saying something to the effect "trust us - we don't need masks". There was a lot of uncertainty early on.
Great article. One point that Matt did raise, but that I think cannot be over stressed is just how bad of an idea it is for public health officials to shade the truth in order to achieve some desired objective. The inaccurate statements on the lack of benefits of masking were incredibly damaging; they both harmed later efforts to encourage masking, and severely undermined confidence in public health officials. I would say the contorted answers to whether the George Floyd protests were a public health threat exacerbated things further.
This selective truth telling is unfortunately a well ingrained habit in the public health community. I remember a particularly clear example from Sweden in the early 1990s, when the fear of HIV was abating among the broad public. It became to be seen, correctly, as something that was just not much of a risk unless if you were gay or injecting drugs. The equivalent of the CDC in Sweden did not like this at all, and attempted to aggressively send a message that there was a dramatic rise in HIV infections from heterosexual sex, and that the utmost vigilance was called for. This was true in a technical sense, but extremely misleading. First, the numbers were tiny, with a rise from lower two digits to just over 100, as I recall. Second, almost all of the recorded cases involved either Swedish sex tourists contracting HIV in Asia, or immigrants from Africa who had contracted it before migrating to Sweden. I can only imagine that public health officials felt they did a good thing because they encouraged safe sex, and were not lying in a strict technical sense. But my take away was that I irrevocably lost trust in them. After that point, I have never taken a statement by a public health expert at face value.
“[T]he contorted answers to whether the George Floyd protests were a public health threat exacerbated things further.”
Yes. This was so disheartening. That was the time when the public health establishment squandered any remaining credibility they had with me. The difference in treatment of BLM protest vs. Sturgis Rally was really discrediting.
Eh, maybe in some media commentary? But in my memory Sturgis was mostly covered as five alarm fire irresponsible mass gathering. (Which, incidentally, I didn’t disagree with at the time). But the tortured defenses of mass gathering to support BLM when it was pretty difficult to parse risk based on public health communications was very confusing and troubling to me. (And, incidentally, I’m someone who might turn out for a BLM protest in other circumstances). Hence, loss of credibility.
I was left feeling that the public health establishment and media had abandoned their role in helping us understand risk in favor of some other opaque political project. It sucked. I realize I’m conflating media and public health here, but in my lived experience of the pandemic I actually couldn’t tell you at any given time what communications were driven by which institutions.
The messaging around protests was not well done, but not inconsistent with the correct information that outdoor activities are a pretty unlikely venue for asymptomatic people to infect others.
Was that the message at the time though? Memory might be faulty but I kind of recall this still being the era of the media publishing zoomed in images of people on "crowded" beaches and saying how irresponsible they were?
It is funny in that it probably wasn't all that much of a risk, given what we now know about how unlikely outdoor transmission is.
But at the time, public health professionals certainly thought it was very dangerous, and there was outrage against not only people on crowded beaches, but in particular against right wingers demonstrating (outdoors!) against covid closures.
Yes. I think And the Band Played On is a great resource that should be more widely read, and this is a big reason why. As a blue diaper baby I was stunned to find out that not all the unconstrained spread of HIV was due to the Reagan Administration; some was due to an attempt in NY and SF to avoid offending the gay community with calls for restrictions.
As an aside, I read And the Band Played On back in the day, and so when I realized that it was still Anthony Fauci who was the go to on infectious diseases I was floored -- I was very young back then and he was a professional and now I am 50 and he is still the guy in charge? It seemed mind boggling -- but then I read that he has been a life long runner and I hoped that I too could hope for similar longevity and critical faculties.
Does the Reagan Administration bear any responsibility for the biggest public health emergency in sixty years emerging entirely under their watch? Yes, it turns out they do. Aside from funding questions, which we might disagree on ideologically, there’s no question that their public health messaging was appalling. Here’s Press Secretary Larry Speake in a press conference:
Lester Kinsolving: Does the president have any reaction to the announcement by the Centers for Disease Control in Atlanta that AIDS is now an epidemic in over 600 cases?
Larry Speakes: AIDS? I haven't got anything on it.
Lester Kinsolving: Over a third of them have died. It's known as "gay plague." [Press pool laughter.] No, it is. It's a pretty serious thing. One in every three people that get this have died. And I wonder if the president was aware of this.
Larry Speakes: I don't have it. [Press pool laughter.] Do you?
Lester Kinsolving: You don't have it? Well, I'm relieved to hear that, Larry! [Press pool laughter.]
Larry Speakes: Do you?
Lester Kinsolving: No, I don't.
Larry Speakes: You didn't answer my question. How do you know? [Press pool laughter.]
Lester Kinsolving: Does the president — in other words, the White House — look on this as a great joke?
Larry Speakes: No, I don't know anything about it, Lester.
"In 1987, President Reagan created a Presidential Commission on the HIV Epidemic. This commission was recruited to investigate what steps are necessary for responding to the HIV outbreak, and the consensus was to establish more HIV testing, focus on prevention and treatment as well as expanding HIV care throughout the U.S. However, these changes were not implemented during this time, and the commission recommendations were largely ignored." https://en.wikipedia.org/wiki/HIV/AIDS_in_the_United_States#Public_health_policies
Note that, even aside from the lack of follow-up, 1987 was *ridiculously* late to simply form a commission for a disease that had been around since early in Reagan's first term.
Tell you what, answer some of my questions first. Shouldn’t the commission’s recommendations have been put into effect? Would doing so have saved lives? If so, isn’t the Reagan Administration culpable for those lives?
“Shouldn’t the commission’s recommendations have been put into effect?”
Perhaps.
“Would doing so have saved lives?”
Perhaps.
“…isn’t the Reagan Administration culpable for those lives?”
No.
Ok, time for my questions:
If 1987 was unconscionably late to have formed a commission, when should Reagan have created a commission? Upon what criteria do you base your answer?
Why are you aiming all of your criticism at the Reagan Administration rather than, for instance, the Clinton Administration. According to the Wikipedia article you linked to Clinton also created an AIDS commission, waited until the last year of his first term to do it, and also ignored its recommendations. Do you hold Clinton responsible for all of the AIDS deaths during his eight years in office? If not, why not?
Relative to California, Florida had a lower death rate from COVID for both the under-65 and the over-65 age cohorts. The age distribution between the states explains the difference in the aggregate result. Regardless, both states were about average. But because the press can't stand Ron DeSantis, the coverage has been irrationally negative.
Was packing restaurants daily with unmasked people months before vaccines were available likely good or bad for public health? Because that was the immediate and foreseeable outcome of DeSantis’s decision, and it’s worthy of criticism.
The results from Florida speak for themselves. Despite the oldest population in the US, the COVID deaths/100k rank #26 among the states. The level of interest and criticism directed toward DeSantis is disproportionate and, in my view, driven by politics not policy. New Mexico, to pick but one example, has a higher death rate than FL. Where is the in-depth analysis of Governor Grisham's (I had to look it up, as I suspect most would need to) decisions? The focus on DeSantis is quite odd to me.
I think DeSantis has sort of courted the interest intentionally, no?
Basically I would say every state didn't do very well. But like Matt says in the piece, blue states were not as locked down as people claimed, and red states had a lot of people refraining from activity.
Additionally, there was some interesting stuff I saw that showed people in California might have been pretty selective about who they spent time with but had much longer interactions. It strikes me the advice of having a "social pod" or something may have actually been damaging if there was no testing/it was imperfectly followed because it would give permission to have longer gatherings indoors.
I think rather than argue about whether DeSantis is good or not we should be looking at why every state (except perhaps Washington, Oregon, and the rural NE states) have unacceptably high death rates. Utah had a low death rate as well but also an exceptionally young population.
The pundits like to slice-and-dice our country into "Lockdown" States and "Open Up Everything" States . . . But I've got news for them, too. We like indoor parties in the Lockdown States, and we don't like restaurant indoor eating unmasked in Open up Everything States. We go to the beach in Lockdown States, and we may think twice about having friends over to the house in Open up Everything States. There are patriots who wore masks everywhere, and patriots who didn't. We are one people, all of us totally confused by chaotic advice coming from our leaders.
You you cite the national ranking of a state that doesn't have winter, you are lying with statistics.
Sure, comparing New Mexico to Florida is more fair. But states that cannot do outdoor activities year 'round like Florida can make comparisons of policies and outcomes....less than high integrity.
This is sort of tangential but I live in New Mexico and we have a Colorado-like winter, also the hypothesis is that head AND humidity slow the spread, which could explain the significant difference between Arizona and Florida despite both having pretty mild temps.
People still go indoors there to use the AC, which facilitates sharing of cool, dry air. The observation that most of the south and southwest had a summer 2020 wave while the rest of the country didn't supports this.
Causing every restaurant I drove by to be packed with unvaccinated persons very, very likely resulted in needless deaths and hospitalizations. I’m sorry I’m not giving a governor credit for the weather and dozens of other factors not under his control.
One of the frustrations arising from the fact that we never stood up robust test and tracing operations is that we probably won’t ever know the answers to these (good) questions. I’m a Georgia resident, and we had similar (lax) rules like Florida. I was critical of reopening indoor dining as early as we did, but in retrospect I wonder if it contributed that much to spread. Even though it was open, lots of people avoided indoor dining (I certainly did) and the capacity regulations probably helped on the margin. My suspicion - again - not able to prove this without tracing data - is that the vast majority of spread occurred in private homes due to lack of centralized quarantine and the kind of reckless gatherings that Matt mentioned. If I recall, Georgia didn’t see a big spike in deaths during this that could be clearly attributed to indoor dining.
If you're a white collar worker it's easy to focus on indoor dining and in-person socializing because those would be your riskiest situations.
But people who can't wfh - in warehouses, in kitchens cooking take-out, in building maintenance, plumbing, carpentry, gov service offices that couldn't close etc. - probably add up to way more hours of exposure and therefore way more of the spread than indoor parties. Many people may have worn masks in those environment, but masks aren't perfect.
I think that’s fair and I probably shouldn’t have stressed indoor partying. Still though, the larger point stands that indoor dining on its own likely wasn’t that big a driver.
There's nothing irrational about being negative with respect to DeSantis's anti-vaccination interference. It's a blatant prioritization of political ambition above public health on his part.
Living in Florida and having seen the Government response, I strongly disagree with your characterization. The distribution of vaccines in FL has been very good, age-based and encouraged by DeSantis.
I'm not referring to Florida's (mediocre) vaccine distribution. I'm referring to DeSantis's support of a law in Florida to interfere with the ability of private businesses to require vaccination of their customers. It's pure MAGA grandstanding, and we both know it. Also, messaging matters: what kind of message do you think DeSantis's position on this issue sends to unvaccinated conservatives everywhere? I'll answer this for you: it makes dangerous behavior into a pro-MAGA, pro-GOP political stance.
We already have a lot of (apolitical) vaccine hesitancy in America. Many people fear needles. Many people are worried about costs. Many worry about side effects. Many Black Americans are aware of the country's dismal history of racist medical experimentation. The last think the country needs is showboat, right-wing anti-vaxxer sentiment (disguised as concern for civil liberties) reinforcing this harmful dynamic. It should be all hands on deck -- across the political spectrum -- to get needless into harms as rapidly as possible. DeSantis is as corrupt and deeply cynical a politician as the country has seen in a long while.
Wow. The caricature of Governor DeSantis has little relation to the actual "lived experience" of this Florida resident. I encourage anyone to be very skeptical of the media narrative around DeSantis rather than the results.
You seem convinced that state-level differences in outcomes are a scorecard of the governor’s office. I’d guess governors are directly responsible for at most 5% of per-capita deaths unless they made really dumb or extreme decisions. It’s entirely possible that no matter the governor, FL was going to do well AND it was dumb to pack restaurants AND DeSantis has been treated unfairly for other reasons.
When the stories all have the same narrative with similar forecasts of mass deaths due to the Governor's decisions, I do look to the state-level outcomes to understand if the stories are accurate or biased. And throughout the pandemic, the level of attention and the relentlessly negative portrayal of largely anodyne and normal governor behavior has convinced me to discount heavily the stories about DeSantis.
Yeah if we de-partisanize this, you can compare the hagiography that cropped up around Inslee in Washington vs. the bashing of Cuomo in New York... IMO it's pretty clear a lot Washington's better performance was just luck. They had a confirmed COVID case Jan 21, but didn't really take any action until early March!
What has been irrational about it? Like just for the sake of argument let’s grant that Desantis did well, I’m not sure I believe that but okay, the last year living and teaching was deeply miserable caught between unrealizable goals of compliance with safety regimes and keeping everything open and not policing behavior.
Like I contrast this with people I know who lived in Asia and it seems like we should be that negative about all of the US.
I'm not in Florida, but at least compared to where I live:
Didn't shut down children's playgrounds
Didn't shut down beaches
Didn't force people to wear masks outdoors in uncrowded conditions
I can't imagine any of the above saved lives, and my guess is it created unsafe conditions by forcing fun/exercise "underground" and / or by encouraging citizens to live unhealthy lifestyles (and develop meaningful risk factors like obesity)
If you unbin that data, Florida has a higher rate than California.
If you collapse it into a “25-30” bin, then yes, they’re both in the same bin. Similarly if you bin the data into “1-100” I’m just as attractive as George Clooney.
The bin's are only 5% wide though - so at most by 5%. But in any case...I'm not sure why that matters? If anything it implies Florida is overcoming a more difficult health starting point than California, in the same way that having an older population means that all-else-equal, Florida should have more covid deaths
1. Priority for vaccine eligibility. After health care workers (and once vaccines became more available, first responders), Florida went strictly by age.
2. Nursing homes: Visitors were prohibited from entering very early on in the pandemic, PPE was made a priority under a state mandate, and there was a separate vaccination program for residents.
In epidemiology, you rarely compare crude death rates. And that's especially true for something like COVID where the case fatality rate varies significantly by age. If you compared the cancer deaths per 100,000 of Japan and Cambodia, it would be much older because about 5% of the population is at least 65 in Cambodia compared to about 28% in Japan.
I suspect the age distribution between the states also explains a good chunk of the higher motor vehicle fatality rate in Florida that Matt cites. Ceteris paribus, old people are bad drivers and die more easily in crashes. Also golf carts don’t typically come with roll cages.
Your bias is showing, desantis coverage has been far more positive than it warrants with all kinds of glowing "winning the pandemic" coverage from politico etc.
I noted at the time of Walensky's no masks for the vaccinated announcement how disheartening it was to see so many public health media types urging the CDC to prevaricate on this. Matt is right that staying in their actual lane of expertise is the best way for experts to serve the public, but it is fundamentally contrary to human nature. People like to opine, as we can all personally attest.
Adjusting for age, Florida did better than California. Yes, Florida had 8% more deaths per capita than California, but it has 42% more seniors per capita (20% versus 14% of the population). COVID was not an equal opportunity killer, 79% of deaths were among seniors. That means, other things constant, Florida’s death rate would have been 23% or 24% higher than California’s.
The difference likely flows from California real estate being too expensive, which means more multigenerational households. Workers who could not afford to quarantine were especially likely to live with parents or grandparents. In other words, the zoning and housing scarcity that MY hates more than nullified the effects of months of coercive distancing.
The more intriguing question is why Florida did better than Texas and the answer is likely Florida did a better job of protecting nursing homes, where targeted interventions can save lots of lives.
You hit the nail on the head. The winter outbreak in SoCal appears to have been largely "essential" workers getting sick at work and coming home to overcrowded often multi generational households. Unsafe working conditions + Housing scarcity.
Random thoughts on other possible explanations . . .
If you accept MY's theory that it is more about people's individual choices to apply those policies to themselves, then it makes sense that more-conservative Texas would do a little worse than less-conservative (though still conservative) Florida.
There is also the weather difference between FL and CA. There are very few days in FL where people need to be inside to stay warm. That isn't true of most of CA.
Covid doesn’t care whether you are in doors for air conditioning or for heat. It’s more pleasant to be outdoors in coastal california during the summer than florida
FL didn’t really get awful Summer heat until a few days ago, so in a crucial time to keep people outdoors, FL’s weather was really helpful this Winter.
What definition of conservative are you using here? The easiest one for me to call to mind is political party preference and FL was 3% for Trump while Texas was 5%. That's only "more conservative" by 1 out of 100 people switching their vote.
Also as David said - being indoors using the AC might be just as bad for sharing air and aerosols. The summer 2020 wave of covid actually tracked "AC season" fairly closely, starting in Arizona in Late May / Early June then shifting north about a state pre month
Among people who say "a return to normalcy," how many are really calling for a return to normal and how many are making an esoteric joke about Warren G. Harding?
I think it's all the former because the phrase is so ingrained in everyone's use of English now, but I, for one, would appreciate a return to 'normality'
On second thought, I guess the parallel abominations should be "realcy", "hostilcy" and "utilcy". And I suppose "animoscy," but that's too much of a monstroscy.
"The people who feel so confident that they could have threaded a perfect bank-shot of mask/vaccine rhetoric to keep the mandates in place longer if they were in Walensky’s shoes aren’t seeing the whole field."
That's not so much a mixed metaphor as it is the product of tossing sewing, billiards, ladies' footwear, and football into a Cuisinart and hitting puree.
The other day a man drove past me on a dirt bike, popping a wheelie down a residential street at dusk, helmetless - but wearing a surgical mask, which he carefully adjusted with one hand after landing his front wheel on the road.
It was funny, but reminded me yet again that normal people just plain suck at any sort of risk assessment. If you are reading through multiple articles to try to figure out how to model the relative risk of various behaviors so you can understand the tradeoffs, then you are a weirdo. As am I.
It's frustrating watching the public health establishment implicitly accept that people suck at this to some degree, but then conclude that that's why they need to manipulate everyone - because they just won't "get it" otherwise. The opposite conclusion is more reasonable: people suck at this, so we should try to make all of our communications simple, clear, fact based, and as far as possible, intuitive. ("People breath the virus out, so if you're gonna spend time inside, open a couple windows" is not something you need a complicated risk assessment to understand) The CDC's communication is far from perfect now, but it's vastly improved since the Trump administration ended.
I was on a shuttle heading to a wedding last weekend for a very progressive and liberal friend of mine who has a very liberal and progressive social circle. I noticed everyone had masks on (and were vaccinated) but I was the only one wearing my seatbelt as we drove down the freeway. Later that night they passed around and drank from a bottle of whiskey and somebody said "hey we're all vaccinated". I thought "yeah, from covid, but not from lots of other diseases". Still drank the whiskey of course of I'm not a complete buzzkill
One issue with that is you can't say "open some windows" without data confirming that will actually work. And since we can't throw random people in a room with someone sick and see what happens and then try it again with a new group and an open window, you're kind of stuck.
Not a dig at you personally, but this kind of thinking drives me crazy. Are we really institutionally unable to reason under uncertainty?
If I kidnapped 100 epidemiologists and lock them in individual rooms with COVID positive patients and a single window, would any of them not open the window and stand next to it?
Life doesn't wait for perfect info for perfect communications. We have to do the best we can with what we have. In April of 2020, that would have meant telling people to open a window if they insisted on being inside with others outside their households.
And if you're honest about the limitations of your data, and why you're making the best recommendation that you can, people are more likely to listen when you update based on new data. If they sense that you're BS'ing them from the start, they're going to suspect that you're still BS'ing them when you change the guidance.
In the kidnapping scenario, the epidemiologists have no cost to opening the window - if it's efficacy isn't negative, they might as well. It might be hygiene theater but there's no cost to them for doing it.
On one hand, reasoning under uncertainty is necessary. But if we have _no_ real data, I think guessing is counter-productive. So I don't need double-blind trials for the open window theory but some evidence other than "epidemiologists would do it if they had no other options" is needed to reason under uncertainty.
It seems like common sense that opening windows increases ventilation and airflow. By how much exactly I don't know. But there are plenty of studies on air circulation so data for making inferences is out there.
My common sense says that if I have 10 people in my dinning room and I open the window on a calm day, the little bit of breeze would somewhat decrease the concentration of viral particles. But not by much.
Picture you're at a dinner party with 10 people in your dining room and a few of them are smoking. Would opening the windows make a little bit of difference in lowering the smoke in the air or a lot?
I was thinking about a Smokey kitchen as an example. It helps a little. But if they or the stove are still smoking it’s still going to be pretty Smokey. Now if you’re saying put a box fan in one of the windows? That would make a huge difference. Especially with some cross ventilation. But that’s a lot more than just open a window.
I have noticed that a lot of people I know are very upset about the CDC rolling back mask requirements and the reason is usually that it freaks them out because it seems unsafe to them. And they’re the type who’ve spent the last year saying the believe in a science. They also spent early 2021 consuming news from sources that insisted we had no idea if the vaccines prevented infections so they also had to get used to the idea that being vaccinated means you almost certainly can’t infect others.
Some of that could have been mitigated if the CDC had done a better job of communicating risk throughout the pandemic.
Or if the CDC had *ever* done a better job of communicating risk. They seem to speak a language entirely of "do"s and "don't"s, with no "A is riskier than B is riskier than C, and you can use this information together with your priorities to determine which things you should and shouldn't do".
Also, I always want to rant about how carcinogens are classified - by strength of *evidence* that an association exists with cancer, and *not* by degree of risk increase:
"The lists describe the level of evidence that something can cause cancer, not how likely it is that something will cause cancer in any person (or how much it might raise your risk). For example, IARC considers there to be strong evidence that both tobacco smoking and eating processed meat can cause cancer, so both are listed as “carcinogenic to humans.” But smoking is much more likely to cause cancer than eating processed meat, even though both are in the same category."
This is all well and good, but seriously what's up with those differences in motor vehicle fatality rates? This table has both the deaths per 100,000 residents, but also per 100 million vehicle miles traveled: https://www.iihs.org/topics/fatality-statistics/detail/state-by-state
By the latter, South Carolina does the worst followed by Mississippi and then New Mexico, but there are a lot clustered around there at 1.4 or 1.5. There's some really good charts here on seatbelt use, alcohol involvement, and types of crashes.
My understanding is that biggest factor in fatal crashes is speed. It make sense that rural areas would have higher fatality numbers because of their speed limits are higher than urban areas. I would be interested to see data on how states implement speed limits to see if that was a major difference in these rankings.
It's not just speed limits: it's just harder to get high speeds in urban environments: frequent stop lights, more traffic, narrower roads, etc. The environment around you even makes the perception of how fast you're going different.
It's also vehicle type. Newer and more expensive vehicles have better safety performance. Rural areas also skew towards trucks - often heavier - which increased impact intensity.
You have to break out safety performance for people inside the vehicle from safety performance for people hit by the vehicle from safety performance for people in another vehicle hit by the vehicle.
"In 2019, the rate of crash deaths per 100 million miles traveled was about 2 times as high in rural areas as in urban areas (1.66 in rural areas compared with 0.86 in urban areas)."
It's also distance to the nearest hospital. The survival rate for a given severity of accident is dramatically higher if you're in the ER within one hour.
I don't know if this is still the case, but at least fairly recently it was legal to drive a moped in SC without a drivers license. And so if someone lost his license due to a drunk driving conviction, he'd just get a moped for the duration. I'm not suggesting that is the cause of their dismal rank, just an indication of the culture. I think it's also the case that they either do not require vehicle inspections, or are very lax about it.
Race downs have much impact on motor vehicle fatality rates with the exception of American Indians. I confess, I expected higher Hispanic rate, but was wrong.
Poverty has very little effect on motor vehicle fatality rates.
Being Southern does have a big effect (whether white or black).
Texas and Louisiana have drive through cocktails, which always struck me as kind of incredible. Not really a California thing, at least not pre-pandemic.
Does southernness correlate with lax DUI laws and enforcement?
Interesting. You might have expected states with more inclement weather to do worse.
As others have pointed out with respect to Covid deaths in another thread, Florida and some other states have a higher portion of very elderly people, who are perhaps more likely to crash.
As interesting is that America doesn't do great on deaths relative to vehicle miles travelled compared to (most) European nations.
There are a few reasons why this might be, one factor is that America has more remote areas where someone involved in an accident will take longer to get help and get to a hospital.
Can we talk about our current airline/airport regulations? I was on a flight a couple of weeks ago which started out with very stern PA messages about mask wearing. And then I spent the rest of the flight with my mask mostly down because the very attentive flight attendant kept bringing me drinks and snacks. For the record I’m fully vaccinated so I’m confident I didn’t put anyone in danger, but I don’t think this is helping our society regain trust in public health messaging.
I've been on several flights in the past month, and my experience was the exact opposite. The flight attendants were very stern about the masks being up and worn properly, even in between sips and bites. It actually struck me as a bit too much, and I was a proper mask wearing fanatic prior to vaccination.
I think we were sunk on a lot of this already last year when the CDC said "masks on inside any time you're not eating" as opposed to "masks on inside, and avoid things you can't do without removing the mask".
The thing is, it's probably fine; not everything you do with your nose and mouth generates the same level of aerosols. If you're sitting there breathing normally (that is to say, fairly shallowly because you're inactive) you probably don't generate too many. If you talk or sing or shout or work out, that's when it's most necessary to have a mask.
I think this is probably right, so for air travel shouldn’t we say the same thing we say to grocery store shoppers: masks are optional for fully vaccinated people?
Something that struck me reading this, which I’m sure others have noted before, is that people who “trust the science” on sex education know that abstinence-only doesn’t work. Many teens will have sex even if you tell them not to, and that what you *can* do is encourage and provide education about safe sex practices while reinforcing that the safest practice is abstinence.
In my experience, well-educated liberals tend to view abstinence-only-in-sex-education advocates as being willfully blind to how humans behave in the real world, and as valuing idealogical purity over achieving the best outcomes.
The analogies write themselves.
"The analogies write themselves."
Absolutely. It drives me nuts when I see people walking down the street wearing condoms after they don't need them anymore.
Condoms do ruin walking, and I've been saying that to my partners for years.
Hey, some people need them. Don't judge. We should all do it out of solidarity with them. https://www.youtube.com/watch?v=VLnWf1sQkjY
That's ridiculous. I'm not going to walk down the street wearing a condom just to show solidarity with other people.
Instead, I'll put it on when I enter the store, to show solidarity with the employees.
Get a lot of weird looks from the greeters at Wal-mart
I tried going without at Wal-Mart a couple weeks ago and the greeter offered me one. She's been there almost every week the whole damn pandemic, so I smiled at her and put it on.
Wait, what are we talking about again?
Yeah, it's almost as if most normal people have terribly scattershot political ideologies with no real logical thru line hahaha.
As someone who is nominally left-leaning, that irony has not been lost on me either, and it's rather depressing.
I've noticed a general trend that people like to say "X doesn't work" when the reality is that "X is not 100% effective". But sometimes, less than 100% is still worth pursuing, and sometimes even an X that is less effective than alternative Y is worth pursuing because some people who can't be convinced to do Y might try X.
It's even more amazing when you consider that senior public health people must have got their start in the late 80s and early 90s, when implementing useful harm reduction strategies around AIDS was a really big deal. Did they all forget how that's supposed to work?
I had this realization some time in early April and it jolted me out of the newly forming mindset.
When we finally got hold of masks here and it was mandatory to wear them, I was waiting in line at a butcher shop. A guy stepped out of the shop and then put on his mask. So I asked him when he normally put on his condom.
I wore masks back in Feb of 2020 because it was obvious that CDC and “experts” were lying or dumb.
I stopped wearing masks as soon as I was fully vaccinated back in March, because it was obvious that science is awesome and experts were lying it dumb about the need to continue.
Also… Florida did better than California because they didn’t keep people inside as much.
California probably killed a non-zero number of people by closing beaches and parks. (Then again, so did every place that restricted people from the outdoors) resulting in people spending more time inside.
I’d like to see more analysis on why people have been so resistive to Covid restrictions and advice. I have a theory.
600K dead. 339M population. Covid killed 0.2% of population. That’s 1 out of every 500 people. Sounds bad. Except that number wasn’t distributed randomly. It was overwhelmingly senior citizens.
One of the artifacts of American culture of the nuclear family vs extended family living arrangements is the elderly are a much smaller percentage of any given person’s acquaintances. We know our grandparents, but after that… most of our acquaintances are people within the same broad age range of us, or younger. We are more likely to know our kids friend than our grandparents friends.
Since I travel for work. Multiple job sites a month. Always with different people, I have started asking people if they know anyone who has died from Covid. I ask strangers on planes. Coworkers. Etc…. And by know, I mean personally. Not friend of friend.
I’ve asked maybe 100-200 people. Only two people have said yes. One was their father in Venezuela. The other was their Grandmother in the US.
I don’t even know anyone who has been in the hospital. I know of people, but don’t know them in any recurring way.
Now, yes… a lot of people have died. I have taken the pandemic seriously from the beginning (I’m naturally risk adverse), but I get why there is a lot of skepticism about the seriousness of Covid.
The media constantly bombarded us with numbers, but there was very very few “faces”. I remember a half dozen cases where there was a young nurse, or a 40-year old dad, but considering there was 600K deaths, the media did a very poor job of putting a human face on. And the reason is simple… the vast majority of deaths were elderly or medically fragile, likely to be obese. People who just don’t garner the same sort of “clicks” as a young nurse.
The simple fact is that the actual disease of Covid didn’t have as much of impact on people’s personal lives as the restrictions did.
When you have this imbalance from daily lives experience and media/experts narrative, it is no surprise that people become skeptical.
I’m not sure how we could of done better as a country. Truthfully given the learning curve and the awesomeness of developing effective vaccines, and having Trump in office, I think on the whole we did pretty good. Shit would of been a lot worse even a decade ago.
Anyway… that’s my dumb take.
Typing on my phone. Forgive any grammatical errors. On my way to Pittsburg for a week and a half. Time to recertify in my job.
Closing the beaches and playgrounds when a large segment of your population lives in crowded housing can actually increase spread within households. But hey, at least people aren’t enjoying themselves in public
Exactly. Hopefully we have learned our lesson.
The lesson will be complicated, though. The next pandemic probably won't be the same as this one, so we won't simply be able to follow the same mitigation strategies that worked this time, and abandon those that didn't. Instead, we'll need to develop a set of principles that will be flexible enough for various possible fact situations.
I think it’s safe to say, that the next pandemic will more likely than not be some sort of airborne spread virus.
It’s not only Covid that they have learned more, it’s also regular flu.
There is such an interesting story or podcast about how scientists have misinterpreted something about the size of the virus and how far it spreads.
Some grad student tracked it back to some paper from I don’t know maybe the 30s or 40s. And it was basically a misquote, which just continually got perpetuated. Sort of like the one in 10 people is gay thing. (among millennials that number is actually strangely accurate though). Folk wisdom of medical science, that never gets verified. It’s just assumed to be fact.
I've been waiting for someone to explicitly say "no one cares about COVID because it's actually very unusual to personally know someone who's died from it". Personally I took it seriously despite not even knowing anyone who knows someone who died from it. But that was more because of concerns about "long COVID" and just not feeling like my life had the bandwidth for a multi-week unplanned vacation to get through the flu.
The way to do better as a country would be to have actually followed the science:
- ventilation ventilation ventilation. No one did much of anything about ventilation
- open up new venues of activity outdoors, rather than closing existing ones
- rapid widespread testing so that people could gather *safely*. Facilitate people getting tested proactively before gathering, rather than reactively after a gathering/traveling/when they have symptoms
The upshot of all this is that you need to clear out a lot of the literal garbage foisted on us by the CDC ("wash your hands without touching the faucet with your hands themselves") state/local government (hygiene theater on NYC subways) and the media in particular the NYT, in particular the reporter Matt is calling out here ("even if you're tested YOU'RE STILL NOT SAFE, so really the only appropriate course of action is to cocoon yourself for the next 18 months").
And finally as Matt has noted several times, probably the only way to clear out the garbage and do the high value stuff like widespread testing, ventilation, etc. is with a federal response - both in pushing the CDC to admit that they screwed up with the surfaces stuff in February, and in providing the financing for eg schools to upgrade their ventilation systems. But Trump is first and foremost incompetent, and his venality comes in at a distant second, so we got inertia.
Anyway TL;DR I approve of your take, I think you're 100% correct and a lot of people should know better.
One other thing. Even people that did know people who died, it was likely to have been someone elderly, that well they sort of knew would die at some point in the not too distant future. Another thing that sounds heartless to say, but is true.
I am really curious about whether we are going to have a mortality compression artifact. It is possible, that in the next 2 to 3 years, we see a lower the normal mortality rate. The only complicated factor is long-haul Covid. However, I confess that I am a little bit skeptical about the severity of long-haul Covid. Some unknown percentage of long haulers, our having psycho somatic symptoms. This is pretty obvious when they say that they recovered when they had the vaccine. Since there is no medical mechanism for why this would happen. Also the demographics of long-haul Covid skew heavily female under 50. I’ve read whispers in the scientific circle about this, but it’s also something that is not possible to say out loud.
Why do the demographics skewing female (or young) mean it's more likely to be psychosomatic?
There will probably be no study that comes out and says "its somatic", just a bunch with theories and no clear explanation.
Problems are many long covid sufferers didn't test positive for covid, and many lack antibodies.
Add in that some long Covid sufferers are suddenly reporting they are cured after receiving the vaccine (no really medical mechanism for this)
Doctors whisper this... but won't publicly say it.
1. somatic disorders are more prevalent in women (reference)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495200/
2. Long covid is twice as likely to affect women
https://www.theguardian.com/society/2021/mar/12/long-covid-more-likely-in-working-age-women-than-in-men-study
3. There is no easily explainable mechanism on why women would have this disproportional amount of long term symptoms. Attempts have been made to say its because women have stronger immune systems, and its an overreaction by immune symptoms, this is just an attempt to explain.
So while not a direct correlation, there is an associative correlation.
Similar to chronic fatigue syndrome, coincidentally (or not).
I do know someone having various intermittent issues (breathing for a while, then neurological) over a year after having semi-serious COVID. He's a pretty rational guy and his wife is a doctor, so he's not making it up, but there's no way to know if it's related or to what degree.
I definitely believe there are some long haul Covid survivors. Your friend is a male, which is less likely to have somatic symptoms. The fact that he had a serious documented case of Covid, which is known to cause lung damage, also makes sense.
However, a pretty significant portion of “long haulers “have no documented cases of Covid, turned up negative on antibody test, and definitely did not have any symptoms or serious symptoms of Covid, yet still say they have serious ailments.
https://www.statnews.com/2020/08/26/long-haulers-dilemma-many-cannot-prove-they-had-covid19/
There was a published study, that sort of talked about this being a possible issue. But it was canceled.
Oh yeah, most of those people are almost certainly suffering from a mental illness of some sort.
My theory sort of dawned on me towards the end of last summer. But it’s like the secret you don’t want to see out loud. That’s when I just started informally asking people. And then when I kept getting no responses, I started looking at the numbers closely, and they mathematically sort of corresponded with my findings.
To tell the truth, I suspect it was an open secret among epidemiologists. But one of those, agree to not speak out loud secrets, because we don’t want people to get lax.
Here is another open secret. Despite people talking about how traumatic the pandemic and lockdown has been. Many people loved it. Honest truth. The month that me and the wife were at home, was awesome. The three months she was out on unemployment getting paid for nothing, was awesome.
I know it probably sucked for some people. People who lived alone. People without close family. But there’s a lot of people that liked it. Enjoyed the forced vacation.
This is another one of those things that people can’t say out loud, because it comes across as callous, but is true.
I'm vaccinated. I know that my wearing a mask isn't really necessary to prevent me from spreading COVID. I continue to wear a mask in stores and other public places where people may not be aware that I am vaccinated because it keeps people who can't effectively get vaccinated from having to worry that I am not, and hopefully encourages other people, including those who are not yet effectively vaccinated, to keep wearing masks.
I think this is well intentioned and probably does help people some. I’m kind of doing the opposite: as I’m vaccinated, I’m going maskless wherever it’s allowed (I’m in LA so that’s not all that many places), with the thought that I’m helping to normalize masklessness. My own bet (based just on intuition I guess) is that there are more vaccinated people who would like to go maskless but don’t want to be the only ones than there are people who can’t get vaccinated and are afraid of maskless people in case they aren’t vaccinated. So as I see it I’m helping people feel like they can take off their masks without being some kind of iconoclast.
I'm so fascinated about how different social behaviors seem to have been. Up until December I was staying in Bryan/College Station, and basically only leaving the house for walks and bike rides around the neighborhood. When I spent a week at an Airbnb in Austin working remotely, I realized I needed to develop a habit of carrying a mask when I left the house. But since January I've been living temporarily in Austin, so I've developed that habit. People generally seem to have been taking things "very seriously" here, but by Texas standards that means wearing a mask while waiting to get seated outdoors at a restaurant, not wearing a mask while actually outdoors (except on the very most crowded part of the bike/run trail). I think having a blue population in a red state may have been the best balance of pandemic protocols. (Though also, there were obviously people eating indoors in all these restaurants for months, and I didn't know what it was like to be them, even though I could infer their existence from the sounds I heard through the doors.)
Austin sounds exactly like where I live about a 1000 miles N/NE of Texas. Definitely not a red state here but outside of the coastal liberal bubble.
It would be interesting to hear from people in the states that were actually meaningfully more successful than the median: Hawaii, Alaska, Oregon, Utah, Maine, Vermont, Washington and hear more about what their policies were.
In the end, though, I suspect local state policies are only about 10-20% of the equation. Weather, density, housing and working conditions and the general health and age profile are probably the dominant factors. Masks, indoor dining and school closings are highly visible and drive emotions but explain a small part of the variance at the end of the day.
I assume anyone wearing a mask is a science denier. Either they are unvaccinated or don’t trust the vaccine.
Either way. I despise masks. Hate them with a passion. Unfortunately I fly often.
Seems uncharitable. The majority of people I know who are keeping their masks on are trying to put other people at ease. Misguided perhaps but hardly denialism.
But the other people either are vaccinated in which case they don’t need to worry, or unvaccinated in which case it’s a choice, and aren’t worried anyway.
Either way. The science is clear. Vaccinations work and are safe and eliminate the need for wearing masks.
So any behavior that is outside this is science denialism, whether it’s out of concern or social signaling.
Also… wearing masks hinders human interaction and communication. Smiling is a way to display trust and acceptance in human beings. So wearing masks has social consequences.
The fact that you cite the social consequences of masks as relevant (which I agree, they are) kind of weakens your position that wearing a mask to put other people at ease is just pure denialism. We do things all the time that are not strictly necessary but help reassure others. Someone with a well-trained dog might still keep it on a leash. A man (sorry for this crass example) who has had a vasectomy and has no STDs will still wear a condom for sex if his partner prefers. Now, as I’ve said I think people should feel free to go maskless—I’m doing it myself—and in the long term that will lead to people being more at ease with masklessness. But the idea that wanting not to alarm others is “denialism” just flies in the face of social convention and courtesy.
Also, you mentioned that the unvaccinated are so by choice. True in most cases, but a lot of blue staters I know have a lot of concern for those who can’t get vaccinated due to immunodeficiency. To be clear, I think the immunocompromised have come to occupy a greatly disproportionate place in this discourse—to hear people talk about it you would think that every tenth person can’t get vaccinated—and I suppose you could call that a sort of denialism. But it’s hard for me to judge people all that harshly for being concerned for unfortunate, at-risk people.
You are absolutely correct.
I confess my passion on this subject is biased on how much I hate masks. My masks always feel damp and irritate my skin. My wife can wear a mask all day with no issues.
Your point about putting people at-ease is why I where a mask. I don't in situations where I can put people at ease that I'm vaccinated. When friends come over, we confirm everyone is vaccinated and take off our masks. At the store, that doesn't really work.
W/respect to immunodeficient people, have you seen a good stat on this? The best I have is that, out of the 10 people in my wife's singing group, one had to drop out b/c the immunosuppressant she takes for MS have prevented her from developing antibodies. At least in that case, it is every tenth person (although this obviously is anecdata).
Re: or unvaccinated in which case it’s a choice
It has been frustrating to me that people don't acknowledge that children under 12 cannot get the vaccine. And yes, I understand the much lower risk to children; but in so many discussions invovling what to do about restrictions, under 12 are not mentioned. Like all unvaccinated people, children are still vectors for Covid. I'm not advocating for a position here, I'm just saying please acknowledge this as part of dicussions. Hopefully September will change this.
Children are an an extremely lower risk. And them Being vectors isn’t relevant to vaccinated people.
"in which case it’s a choice, and aren’t worried anyway."
You're forgetting the non-zero percentage of the population that is both anti-vax and scared of COVID.
I have yet to meet anyone that fits this description. But they are of course welcome to wear masks. They still fall into the science denier category.
I think we really have underestimated how much masks hinder communication. Many people perceive a masked face as more threatening than an unmasked face. And this is a big problem for people with dementia who in many cases have seen very few unmasked faces in the past year.
Misguided. Everything Rory says. Makes socializing so awkward and a reminder of the various social tensions that covid has created.
But we don’t need to socialize with the vast majority of people we come across. To be clear, I support masklessness and want to get there sooner (see my earlier comment) but I think judging people for being at whatever comfort level they’re at, or for trying to put other people at ease, is useless and counterproductive.
I don't disagree with that. I'm just focusing in on the part where people think they are putting others at ease and questioning whether that's actually the impact. I know for me, personally, it does quite the opposite, it makes me very uneasy. Mainly because of the horrible political, social, and sometimes racial tensions covid has caused or exacerbated. I think mask-wearing by the vaccinated, at this point, feeds into those tensions without doing anything tangible for public health.
It's just my 2 cents but I don't think I'm the only person who feels like arguments for trusting the democrats are undermined when masking rules and behavior make no sense.
It doesn't make socializing awkward, because, if you are at the point of socializing, you can confirm that everyone is vaccinated and, if so, take off the mask.
I meant socializing much more loosely than that. I'm thinking about ordering food and being misunderstood, or watching my kid play in the playground and so sometimes interacting with other parents or kids. Or random interactions on the street or in a hotel. Things like that are more awkward. I don't know anybody who's wearing the mask in private gatherings.
I am continually amazed by the people who continue to wear masks outdoors, even in the sun. I have an urge to stop them and say, “Dude, there’s a CVS right down the street giving out vaccinations.”
In Asia people wear masks to help with allergies. I know a few people who have said that wearing masks outdoors has really helped their allergies and they will continue the practice after the pandemic.
This is actually a very good point.
In Asia?
Whenever the lawnmowers are out in force these days I'm thankful that I always have a mask in my pocket. I put it on when I enter a business, or a home, but usually take it off a moment later if it's clear it's not needed, but for the lawnmowers it's always helpful.
I may have made a few unsolicited comments to masked people…
You shouldn’t do that! They aren’t hurting you—yes, social impacts, whatever, but you don’t need to exchange smiles with everyone on the street. Just live and let live!
You are right. I try and be nice, but fail sometimes.
It's interesting to hear that because when I see people with masks on at this point I immediately wonder "what are they thinking?" Are they anti-vax? Are they trying to show some kind of loyalty to Team Blue? Is there a rule in this store I'm not aware of? Are they going to judge me for not wearing one? Do they not understand that vaccinations work really well? When does this end? It raises all those questions and ultimately leaves me feeling frustrated and resentful towards them.
Yeah same but it's really getting old on me and at some point I'm gonna say "fuck it" and let people assume my good intent.
>>>California probably killed a non-zero number of people by closing beaches and parks.>>>
I spent Feb-June 2020 in the Bay Area. I visited the park in my town (Menlo Park) virtually every day, and went hiking frequently in county (state?) parks in the Santa Cruz Mountains. I also visited the beach multiple times. I had zero access problems.
I don't disagree it's stupid to close parks/beaches. But that's not what I was seeing.
I think it was just localities. I remember seeing something about beaches and maybe Long Beach or one of tthose other Southern California places.
You wrote, "Also… Florida did better than California because they didn’t keep people inside as much." Matt's article says "On a per-capita basis, Florida had 8% more deaths [than CA]"
So I'm wondering if you're using a different metric than deaths per capita or disagree with Matt's numbers?
To add to your sample, my grandmother died of COVID in FL. My understanding is she got it from her in-home caretaker who got it from a young family member who attended indoor social gatherings during lockdown.
I am sorry about your grandmother. Many people were especially callous about the risk they presented to other people.
Florida did better when taking into account age adjusted risk.
Since Covid outcomes was overwhelmingly based on age. You have to ask… were you safer as a 60-year old in Florida or California? (The answer is Florida). This is not to discount what happened in your family.
Just that Florida’s spent more time outside than places that had more restrictive lockdowns.
Risk assessment and trade offs are the biggest loser in the pandemic.
It’s become almost sacrilege to say, but everything in life is a risk.
By driving to work, I risk hitting a pedestrian. The pedestrian risks being hit by a car by leaving the house.
Now obviously there’s really risks and restrictions trade offs. I’m not sure where to draw the line.
I had no choice. My job continued during pandemic. I traveled.
Now I don’t have much sympathy for people who don’t get vaccinated, but they don’t present a risk to me as someone who is vaccinated.
I also am very worried about the long term costs of the pandemic. For instance schools. There is a very real chance we hamstring a whole generation of kids. Increased inequality.
I think there are serious questions about whether some of the restrictions were worth it.
https://alachuachronicle.com/yes-the-covid-mortality-rate-is-higher-in-california-than-florida/
Ah, this makes sense (to save anyone a click - the age-adjusted mortality rate is lower in FL than in CA) and I think that's a good point. I think Florida did a lot right (their treatment of nursing homes versus NY) and not keeping people indoors.
CA is above the national average for vaccinations and FL is below - so we'll see if FL is able to continue having fewer deaths per capita going forward but it's probably not that far apart (72% vs 62% with one dose) to make much difference.
Interesting I've been shocked as parties and BBQs and such have started up again how many people have tales of being very sick, hospitalized, still suffering breathing problems months later, etc. And these are people in their 30s and 40s.
I wonder if it’s a result of our social circles. I’m assuming that you live in NYC and have a more liberal social base.
Perhaps my more conservative associates play it down and perhaps more liberal people play it up.
The numbers say that people in their 30s or 40s would have an extremely low chance of being hospitalized. (3.9%). Given that infection rate was really about 20% of population. This means that only about 1 out of 100 people between the age of 30-39 would of been hospitalized.
Even if 100% of NYC had been hospitalized, only 1 out of 25 people this age would have been hospitalized.
For ongoing symptoms the rate was 31% of Covid sufferers (sel-reported). This means that with a 20% infection rate, 6 out of 100 people would have ongoing symptoms.
At some point you have to ask why everyone you know says they won in Vegas, yet Vegas is still paying their electricity bill.
Note: my estimates don’t take into account that hospitalization was centered those who were obese and had other commodities. Curious as to whether those who say they were hospitalized were more likely to be obese or have other medical conditions.
https://www.circle-health.org/health-and-wellness/health-library/odds-of-hospitalization-death-with-covid-19-rise-steadily-with-age-study
6 out of 100 is 1 in 16. If you have 30 people at a party roughly two of them would have ongoing symptoms. I would add that at least with my small sample, the people with ongoing symptoms had a really rough experience even if they didn't end up being admitted to the hospital. As an example laying in bed all night thinking...if it gets any harder to breath then I'm going to the ER. There are also those who had the "if it gets harder to breath I'm going to the ER" experience who didn't end up needing to go the ER and don't have ongoing symptoms. They were just really sick.
That makes sense. I suspect NYC infection rate was higher as well.
It’s so hard to evaluate anecdotal evidence.
I’m glad u are having BBQs there in NYC finally. I was in NYC a while ago and it was sad seeing the streets so empty.
I love hustle and bustle of New York City.
One strange part of this is that one BBQ was at my antivax Trump loving brother in law's lake house in NH. The weird part of it is that he's convinced COVID is no big deal and he doesn't need to get vaccinated despite his 30 something best friend almost dying of it and his neighbor (late 40s maybe?) having a really bad time and still having breathing problems months later. People are weird.
On a side not. I love this substack. I suspect we might have different views. Then again maybe not. But discussion is so civilized here and I learn a lot.
I’m a weird combination of skeptic and precaution taker. I suspect some parts of Covid were overblown in media. But I also believed in masks and vaccines.
I don’t know that many people who died but my life was so turned upside down for so long it’s staggering to me. I really can’t understate how constant the disruption was from March 2020 to the end of school it was an endless string of muddling through without either safety or normalcy.
Yes. I think it was especially traumatized for kids and younger people.
One thing NPR has done well is reporting on the lives of COVID victims by. It may have not been strictly statistically representative, but it gave a good sense of the spectrum of those affected.
I’m not so sure. NPR listeners are overall progressive. So their balance of stories may have skewed people’s risk evaluations. My take is that progressives overestimated personal risk whereas Conservatives underestimated it. Both were counterproductive.
Then again, perhaps my assessment is skewed or wrong as well.
The problem is that people overly dichotomize risk; the anecdata that the NPR reports provided anecdata that temporized the lack of firsthand acquaintance with people getting sick who were heuristically treating the problem as negligible. Progressives who overestimated risk had already maximized their fears so the NPR reporting could do little to increase that.
This is a really interesting perspective. Your anecdote about asking so many people whether they knew someone who died of covid and finding so few is surprising but, by the numbers, makes perfect sense. I unfortunately lost 2 family members and about a dozen patients. Thinking about the way the experience of the worst outcomes have been distributed, I suppose there is cause to be more thankful so many have been as diligent about masking and other measures. Your take is hopeful in yeah way and I appreciate it. Also, enjoy the Burgh. I think it’s a great place to visit.
I suspect that a few people know many people who died. For instance my grandmothers boyfriend died, as well as many of her friends. She survived it at the age of 92.
It’s just the distribution of social circles. And also a sad commentary on how Americans are disconnected from our senior citizens.
Also. Assuming you are a medical person, thank you for all you did. My ex-wife is a nurse (we are still friends) and her experience was a lot more challenging than mine.
Something about covid just seems to have broken the brains of a lot of blue state liberals. How do you ever convince yourself it would be a good idea for the government to mislead the public about the effectiveness of public health interventions in order to put pressure on recalcitrant governors?
Public health people should tell the truth about public health matters. Governors who ignore or subvert guidance should be judged by their electorates. Why does this even need spelling out?
I'm so sick of the people who think it's the government's job to play jedi mind tricks to manipulate the population into doing things. It's the government's job to provide information and reasonable guidance informed by that information.
So instead of saying, "Masks only work for doctors; regular schmucks like you can't possible use them correctly," they should have said, "Masks are useful, but doctors and first responders need them more than you do, so please don't horde them." Instead of saying "COVID is a serious risk for your average 20-year-old, so get vaccinated to save yourself", say "The risk of COVID to your average 20-year-old isn't very big, but please take one for the team and get vaccinated to help people at higher risk than you."
The people who advocate for these jedi mind tricks tend to also be the people who wonder why the people who don't fall for these jedi mind tricks have such low faith in government. Just treat people like adults. If you want to change people's mind, hire Frank Luntz to manipulate people like adults https://debeaumont.org/news/2021/focus-group-vaccines-republicans/ (Not a sentence I expected to type.)
My observation has been that academic schools of public health are extremely paternalistic, and tend to attract students who are both earnest and highly controlling.
Yes, this is a good point. I am a graduate student in public health and the default position here for any given issue is that the government should dictate what people can do.
It’s worth noting that “The people who advocate for these jedi mind tricks tend to also be the people who wonder why the people who don't fall for these jedi mind tricks have such low faith in government” is natural when you think about it - they’re just projecting their own credulity downward.
Agreed. It's both expected and super frustrating. I wish more people had a more developed theory of the mind https://slatestarcodex.com/2015/11/03/what-developmental-milestones-are-you-missing/
This is exactly right. This idea that you can turn around people who are skeptical of government officials by shading the truth is nuts. You just provide ammunition for the people who want to undermine the message. Sticking to the facts is a much better strategy.
Obviously I think this whole thing was glorious, but I think you (and just about everyone) is being too credulous with the public health people saying “oh of course we didn’t think masks were useless, haha we knew the whole time, we were just trying to manipulate people”. As Zeynep Tufekci has written (https://www.nytimes.com/2021/05/07/opinion/coronavirus-airborne-transmission.html), it wasn’t obvious to the “experts” that the virus was airborne for quite a while, and they were also pushing ridiculous hand-washing techniques at least through June.
Isn’t it at least as likely that they had no idea that masks were useful, that they were relying on (completely irrelevant) studies showing improper mask use is worse than no mask use with surface-transmissible viruses, and that they’re only coming up with this “we wanted to protect our Healthcare Heroes (tm)” rationale after the fact?
Agreed.
And WHO didn't change their recommendation on masks until June, 2020. Fauci/CDC did so in early April. Pretty clearly the science of all this was in flux for months, and the public record reflects this.
As a scientist, what irks me is now the public wants the government to dial up "the scientists" and get "the answer". We do what we do and give a detailed, nuanced answer based on the current best understanding. And when that understanding---of a novel coronavirus a few months after it was discovered---changes, suddenly "the scientists" were wrong about everything.
Same with the lab-leak hypothesis, where journalists went and asked "the scientists" when the consensus was essentially "default hypothesis is zoological, but cannot rule out lab leak", Team Red reported "scientists confirm China unleashed bio-weapon" while Team Blue reported "scientists rule out lab leak".
I mainly stuck to reading about everything in scientific journals and ignored the media, because I could, and was blown away when the deluge of "suck it, people who don't share my political views" stories came out about the lab leak and now---again---about masks.
I agree with all of that but under the surface here is some variation in rigor between (say) chemistry and epidemiology that gets obscured by the label “science”. At this point it’s clear that epidemiology as practiced has more in common with folk wisdom than is readily apparent when labeled “science”.
I happen to be a (Physical) Chemist and I could not agree more. Much of what we call "science" these days is, in practice, applied statistics. I'm not knocking other disciplines and I'm saying that epidemiology is not a science, but it is too easy to hide behind p-values and declare confirmation bias rigorous. And then to get your back up on Twitter when someone questions your fast-tracked-to-publication that made it into Nature because of the salience of the pandemic. Oh, and don't get me started on the abuse and misunderstanding of epidemiological models.
The literature that I was reading was more along the lines of modeling aerosol dispersion using fluidic dynamics, evaluating the pressure drop across various mask materials, measuring the longevity of fomites, etc. My wife commented several times that we always seemed to be ahead of the RIVM (the Dutch version of the CDC) when they rolled out new guidance. On that note, I appreciated how the RIVM held the line on school closures, citing the lack of evidence that keeping them open was dangerous in the face of an angry and panicked public.
Yeah this is exactly what I have in mind. What seems to be missing is a public understanding of the difference between a science that builds a theory vs. a science that confirms/debunks a bunch of disjoint hypotheses.
As a non-scientist, I was frustrated by scientists basically saying “shut up until there are peer review articles.”. Even in March of 2020, anyone who had studied what happened on the Diamond Princess and knew a little about other coronaviruses would have been fairly confident that 1) many infections had few or no symptoms and 2) the primary route of transmission was airborne.
I was deeply frustrated at some of the things people said in their capacity as scientists, like completely debasing themselves by signing these letters proclaiming things to be true that were not the scientific consensus. I'm not going to tell anyone to shut up, but at the start of the pandemic, I read papers from previous outbreaks (e.g., SARS) and it ended up mapping on to COVID pretty well; generally, I mean, about transmission, mask effectiveness, that kind of thing.
The lack of understanding of exactly how the virus spreads was definitely one component.
But I am pretty sure the "save PPE for medical workers" rationale was also on their minds. After all, they did consider masks essential for medical workers, so it is not like they thought they were ineffective.
Moreover, isn't the rationale *more* damning to them? That one involves deliberate lying.
So the way to explain their consideration that masks were “essential” is to remember that hospitals were never going to tell doctors that they don’t need masks for a million and a half different self-interested reasons. Consequently, public health officials showing up and saying that masks are completely irrelevant even for Healthcare Heroes was going to spark a lot more backlash. So the way to hedge was to say masks provide >=0 utility for “trained professionals” but <=0 utility for savages. But in their minds masks had exactly 0 utility even for pros.
Now I agree that it’s not obvious what’s correct, but I don’t view public health people’s regard for masks for HC workers as evidence one way or the other. I think the more compelling evidence is that all these public health people were hanging out at conferences about the importance of hand washing without masks.
I think it's actually a combination of the two. The conventional understanding (at least as I was taught pre-pandemic) is that surgical masks are best as source control. They're primarily effective in stopping a sick person from spreading particles and only have marginal benefit when worn by the healthy person interacting with them. This means that the effectiveness of masking primarily depends on the number of sick people present and at the time we were only beginning to appreciate the prevalence of asymptomatic infection. So in the face of shortages, masking in hospitals is much more efficient than masking healthy people even if it has non-zero benefits. I remember listening to an April 2020 JAMA podcast where Dr. Fauci said basically that. Mask wearing might have some individual benefit but because most people aren't around a lot of COVID patients it would be small and on balance saving PPE for hospitals would do much more good.
[lack of edit button] personally I think deliberately lying is less damning because they’re then lying for the greater good. In the “they’re morons” version, they’re claiming the mantle of “science” while practicing something more akin to health marketing.
I’m very confused. Weren’t doctors and nurses treating Covid patients wearing N95 masks from the beginning? Was this just an issue of recognizing asymptomatic transmission?
In some cases, but in many places there were shortages of PPE so they were stuck with les effective surgical masks
Right, but not because they didn’t think it was transmitted via aerosol, they were just doing the best they could.
They believed it was mainly small particles unless aerosol generating procedures were used. Given the proximity and context length it still made sense to wear N95 masks based on that alone though.
Absolutely.
Yes but doctors/nurses and public health officials are (usually very) different people.
I've struggled trying find it again, but there was a tweet from an epidemiologist at a conference circa Feb. 2020 of a picture of something like 50-100 people in a room, most without masks, saying something to the effect "trust us - we don't need masks". There was a lot of uncertainty early on.
Great article. One point that Matt did raise, but that I think cannot be over stressed is just how bad of an idea it is for public health officials to shade the truth in order to achieve some desired objective. The inaccurate statements on the lack of benefits of masking were incredibly damaging; they both harmed later efforts to encourage masking, and severely undermined confidence in public health officials. I would say the contorted answers to whether the George Floyd protests were a public health threat exacerbated things further.
This selective truth telling is unfortunately a well ingrained habit in the public health community. I remember a particularly clear example from Sweden in the early 1990s, when the fear of HIV was abating among the broad public. It became to be seen, correctly, as something that was just not much of a risk unless if you were gay or injecting drugs. The equivalent of the CDC in Sweden did not like this at all, and attempted to aggressively send a message that there was a dramatic rise in HIV infections from heterosexual sex, and that the utmost vigilance was called for. This was true in a technical sense, but extremely misleading. First, the numbers were tiny, with a rise from lower two digits to just over 100, as I recall. Second, almost all of the recorded cases involved either Swedish sex tourists contracting HIV in Asia, or immigrants from Africa who had contracted it before migrating to Sweden. I can only imagine that public health officials felt they did a good thing because they encouraged safe sex, and were not lying in a strict technical sense. But my take away was that I irrevocably lost trust in them. After that point, I have never taken a statement by a public health expert at face value.
“[T]he contorted answers to whether the George Floyd protests were a public health threat exacerbated things further.”
Yes. This was so disheartening. That was the time when the public health establishment squandered any remaining credibility they had with me. The difference in treatment of BLM protest vs. Sturgis Rally was really discrediting.
I thought with Sturgis the issue was all the bars?
Eh, maybe in some media commentary? But in my memory Sturgis was mostly covered as five alarm fire irresponsible mass gathering. (Which, incidentally, I didn’t disagree with at the time). But the tortured defenses of mass gathering to support BLM when it was pretty difficult to parse risk based on public health communications was very confusing and troubling to me. (And, incidentally, I’m someone who might turn out for a BLM protest in other circumstances). Hence, loss of credibility.
I was left feeling that the public health establishment and media had abandoned their role in helping us understand risk in favor of some other opaque political project. It sucked. I realize I’m conflating media and public health here, but in my lived experience of the pandemic I actually couldn’t tell you at any given time what communications were driven by which institutions.
The messaging around protests was not well done, but not inconsistent with the correct information that outdoor activities are a pretty unlikely venue for asymptomatic people to infect others.
Was that the message at the time though? Memory might be faulty but I kind of recall this still being the era of the media publishing zoomed in images of people on "crowded" beaches and saying how irresponsible they were?
It is funny in that it probably wasn't all that much of a risk, given what we now know about how unlikely outdoor transmission is.
But at the time, public health professionals certainly thought it was very dangerous, and there was outrage against not only people on crowded beaches, but in particular against right wingers demonstrating (outdoors!) against covid closures.
Yes. I think And the Band Played On is a great resource that should be more widely read, and this is a big reason why. As a blue diaper baby I was stunned to find out that not all the unconstrained spread of HIV was due to the Reagan Administration; some was due to an attempt in NY and SF to avoid offending the gay community with calls for restrictions.
As an aside, I read And the Band Played On back in the day, and so when I realized that it was still Anthony Fauci who was the go to on infectious diseases I was floored -- I was very young back then and he was a professional and now I am 50 and he is still the guy in charge? It seemed mind boggling -- but then I read that he has been a life long runner and I hoped that I too could hope for similar longevity and critical faculties.
Much as you may love running, it has much less to do with Fauci's longevity and mental clarity than his choice of parents.
“…not all the unconstrained spread of HIV was due to the Reagan Administration…”
Was any of it?
Does the Reagan Administration bear any responsibility for the biggest public health emergency in sixty years emerging entirely under their watch? Yes, it turns out they do. Aside from funding questions, which we might disagree on ideologically, there’s no question that their public health messaging was appalling. Here’s Press Secretary Larry Speake in a press conference:
Lester Kinsolving: Does the president have any reaction to the announcement by the Centers for Disease Control in Atlanta that AIDS is now an epidemic in over 600 cases?
Larry Speakes: AIDS? I haven't got anything on it.
Lester Kinsolving: Over a third of them have died. It's known as "gay plague." [Press pool laughter.] No, it is. It's a pretty serious thing. One in every three people that get this have died. And I wonder if the president was aware of this.
Larry Speakes: I don't have it. [Press pool laughter.] Do you?
Lester Kinsolving: You don't have it? Well, I'm relieved to hear that, Larry! [Press pool laughter.]
Larry Speakes: Do you?
Lester Kinsolving: No, I don't.
Larry Speakes: You didn't answer my question. How do you know? [Press pool laughter.]
Lester Kinsolving: Does the president — in other words, the White House — look on this as a great joke?
Larry Speakes: No, I don't know anything about it, Lester.
In what sense was it an emergency? I mean, once it was figured out?
I don't understand the question. 30,000 people died of AIDS in the last two years of Reagan's presidency alone.
Is that a lot?
"In 1987, President Reagan created a Presidential Commission on the HIV Epidemic. This commission was recruited to investigate what steps are necessary for responding to the HIV outbreak, and the consensus was to establish more HIV testing, focus on prevention and treatment as well as expanding HIV care throughout the U.S. However, these changes were not implemented during this time, and the commission recommendations were largely ignored." https://en.wikipedia.org/wiki/HIV/AIDS_in_the_United_States#Public_health_policies
Note that, even aside from the lack of follow-up, 1987 was *ridiculously* late to simply form a commission for a disease that had been around since early in Reagan's first term.
When should he have created the commission? And why?
1982. Because a new infectious disease was spreading that was clearly killing people.
It was spreading very slowly and no one knew much about it.
Tell you what, answer some of my questions first. Shouldn’t the commission’s recommendations have been put into effect? Would doing so have saved lives? If so, isn’t the Reagan Administration culpable for those lives?
“Shouldn’t the commission’s recommendations have been put into effect?”
Perhaps.
“Would doing so have saved lives?”
Perhaps.
“…isn’t the Reagan Administration culpable for those lives?”
No.
Ok, time for my questions:
If 1987 was unconscionably late to have formed a commission, when should Reagan have created a commission? Upon what criteria do you base your answer?
Why are you aiming all of your criticism at the Reagan Administration rather than, for instance, the Clinton Administration. According to the Wikipedia article you linked to Clinton also created an AIDS commission, waited until the last year of his first term to do it, and also ignored its recommendations. Do you hold Clinton responsible for all of the AIDS deaths during his eight years in office? If not, why not?
Relative to California, Florida had a lower death rate from COVID for both the under-65 and the over-65 age cohorts. The age distribution between the states explains the difference in the aggregate result. Regardless, both states were about average. But because the press can't stand Ron DeSantis, the coverage has been irrationally negative.
Was packing restaurants daily with unmasked people months before vaccines were available likely good or bad for public health? Because that was the immediate and foreseeable outcome of DeSantis’s decision, and it’s worthy of criticism.
The results from Florida speak for themselves. Despite the oldest population in the US, the COVID deaths/100k rank #26 among the states. The level of interest and criticism directed toward DeSantis is disproportionate and, in my view, driven by politics not policy. New Mexico, to pick but one example, has a higher death rate than FL. Where is the in-depth analysis of Governor Grisham's (I had to look it up, as I suspect most would need to) decisions? The focus on DeSantis is quite odd to me.
I think DeSantis has sort of courted the interest intentionally, no?
Basically I would say every state didn't do very well. But like Matt says in the piece, blue states were not as locked down as people claimed, and red states had a lot of people refraining from activity.
Additionally, there was some interesting stuff I saw that showed people in California might have been pretty selective about who they spent time with but had much longer interactions. It strikes me the advice of having a "social pod" or something may have actually been damaging if there was no testing/it was imperfectly followed because it would give permission to have longer gatherings indoors.
I think rather than argue about whether DeSantis is good or not we should be looking at why every state (except perhaps Washington, Oregon, and the rural NE states) have unacceptably high death rates. Utah had a low death rate as well but also an exceptionally young population.
The pundits like to slice-and-dice our country into "Lockdown" States and "Open Up Everything" States . . . But I've got news for them, too. We like indoor parties in the Lockdown States, and we don't like restaurant indoor eating unmasked in Open up Everything States. We go to the beach in Lockdown States, and we may think twice about having friends over to the house in Open up Everything States. There are patriots who wore masks everywhere, and patriots who didn't. We are one people, all of us totally confused by chaotic advice coming from our leaders.
You you cite the national ranking of a state that doesn't have winter, you are lying with statistics.
Sure, comparing New Mexico to Florida is more fair. But states that cannot do outdoor activities year 'round like Florida can make comparisons of policies and outcomes....less than high integrity.
This is sort of tangential but I live in New Mexico and we have a Colorado-like winter, also the hypothesis is that head AND humidity slow the spread, which could explain the significant difference between Arizona and Florida despite both having pretty mild temps.
People still go indoors there to use the AC, which facilitates sharing of cool, dry air. The observation that most of the south and southwest had a summer 2020 wave while the rest of the country didn't supports this.
Arizona's winter surge was much bigger than it's summer increase.
Yes - but it did have a summer wave at a time when covid was still receding in the rest of the country. And that wave was timed with AC season.
The point isn't that summer was worse than winter - it's that summer isn't as low as we might suppose if many people are indoors using AC.
Causing every restaurant I drove by to be packed with unvaccinated persons very, very likely resulted in needless deaths and hospitalizations. I’m sorry I’m not giving a governor credit for the weather and dozens of other factors not under his control.
One of the frustrations arising from the fact that we never stood up robust test and tracing operations is that we probably won’t ever know the answers to these (good) questions. I’m a Georgia resident, and we had similar (lax) rules like Florida. I was critical of reopening indoor dining as early as we did, but in retrospect I wonder if it contributed that much to spread. Even though it was open, lots of people avoided indoor dining (I certainly did) and the capacity regulations probably helped on the margin. My suspicion - again - not able to prove this without tracing data - is that the vast majority of spread occurred in private homes due to lack of centralized quarantine and the kind of reckless gatherings that Matt mentioned. If I recall, Georgia didn’t see a big spike in deaths during this that could be clearly attributed to indoor dining.
If you're a white collar worker it's easy to focus on indoor dining and in-person socializing because those would be your riskiest situations.
But people who can't wfh - in warehouses, in kitchens cooking take-out, in building maintenance, plumbing, carpentry, gov service offices that couldn't close etc. - probably add up to way more hours of exposure and therefore way more of the spread than indoor parties. Many people may have worn masks in those environment, but masks aren't perfect.
I think that’s fair and I probably shouldn’t have stressed indoor partying. Still though, the larger point stands that indoor dining on its own likely wasn’t that big a driver.
New York, which probably has decent contact tracing looked at indoor dining‘a role and they were able to link very few cases to indoor dining.
There have been a large number of cases traced to restaurant kitchens.
I haven't heard any results from any contact tracing in the United States so I assumed it just never ended up happening in any systematic way.
"...packing restaurants daily with unmasked people months before vaccines were available..."
Pics or it didn't happen.
There's nothing irrational about being negative with respect to DeSantis's anti-vaccination interference. It's a blatant prioritization of political ambition above public health on his part.
Living in Florida and having seen the Government response, I strongly disagree with your characterization. The distribution of vaccines in FL has been very good, age-based and encouraged by DeSantis.
I'm not referring to Florida's (mediocre) vaccine distribution. I'm referring to DeSantis's support of a law in Florida to interfere with the ability of private businesses to require vaccination of their customers. It's pure MAGA grandstanding, and we both know it. Also, messaging matters: what kind of message do you think DeSantis's position on this issue sends to unvaccinated conservatives everywhere? I'll answer this for you: it makes dangerous behavior into a pro-MAGA, pro-GOP political stance.
We already have a lot of (apolitical) vaccine hesitancy in America. Many people fear needles. Many people are worried about costs. Many worry about side effects. Many Black Americans are aware of the country's dismal history of racist medical experimentation. The last think the country needs is showboat, right-wing anti-vaxxer sentiment (disguised as concern for civil liberties) reinforcing this harmful dynamic. It should be all hands on deck -- across the political spectrum -- to get needless into harms as rapidly as possible. DeSantis is as corrupt and deeply cynical a politician as the country has seen in a long while.
Wow. The caricature of Governor DeSantis has little relation to the actual "lived experience" of this Florida resident. I encourage anyone to be very skeptical of the media narrative around DeSantis rather than the results.
You seem convinced that state-level differences in outcomes are a scorecard of the governor’s office. I’d guess governors are directly responsible for at most 5% of per-capita deaths unless they made really dumb or extreme decisions. It’s entirely possible that no matter the governor, FL was going to do well AND it was dumb to pack restaurants AND DeSantis has been treated unfairly for other reasons.
When the stories all have the same narrative with similar forecasts of mass deaths due to the Governor's decisions, I do look to the state-level outcomes to understand if the stories are accurate or biased. And throughout the pandemic, the level of attention and the relentlessly negative portrayal of largely anodyne and normal governor behavior has convinced me to discount heavily the stories about DeSantis.
Yeah if we de-partisanize this, you can compare the hagiography that cropped up around Inslee in Washington vs. the bashing of Cuomo in New York... IMO it's pretty clear a lot Washington's better performance was just luck. They had a confirmed COVID case Jan 21, but didn't really take any action until early March!
I grew up in FL and currently still have lots of family there. Their lived experiences are very different from yours.
What were their experiences? Mine was that I was able to get vaccinated in Florida about a month and a half earlier than colleagues in New Jersey.
What has been irrational about it? Like just for the sake of argument let’s grant that Desantis did well, I’m not sure I believe that but okay, the last year living and teaching was deeply miserable caught between unrealizable goals of compliance with safety regimes and keeping everything open and not policing behavior.
Like I contrast this with people I know who lived in Asia and it seems like we should be that negative about all of the US.
To what action do you credit Ron DeSantis with that result, specifically? Or is just ad hoc, ergo propter hoc?
I'm not in Florida, but at least compared to where I live:
Didn't shut down children's playgrounds
Didn't shut down beaches
Didn't force people to wear masks outdoors in uncrowded conditions
I can't imagine any of the above saved lives, and my guess is it created unsafe conditions by forcing fun/exercise "underground" and / or by encouraging citizens to live unhealthy lifestyles (and develop meaningful risk factors like obesity)
Florida has a higher rate of adult obesity than California.
Not according to the CDC. Each state has 25% - 30%.
https://www.cdc.gov/obesity/data/prevalence-maps.html
If you unbin that data, Florida has a higher rate than California.
If you collapse it into a “25-30” bin, then yes, they’re both in the same bin. Similarly if you bin the data into “1-100” I’m just as attractive as George Clooney.
How much higher, George?
The bin's are only 5% wide though - so at most by 5%. But in any case...I'm not sure why that matters? If anything it implies Florida is overcoming a more difficult health starting point than California, in the same way that having an older population means that all-else-equal, Florida should have more covid deaths
Because of covid?
or because of DeSantis?
1. Priority for vaccine eligibility. After health care workers (and once vaccines became more available, first responders), Florida went strictly by age.
2. Nursing homes: Visitors were prohibited from entering very early on in the pandemic, PPE was made a priority under a state mandate, and there was a separate vaccination program for residents.
In epidemiology, you rarely compare crude death rates. And that's especially true for something like COVID where the case fatality rate varies significantly by age. If you compared the cancer deaths per 100,000 of Japan and Cambodia, it would be much older because about 5% of the population is at least 65 in Cambodia compared to about 28% in Japan.
I suspect the age distribution between the states also explains a good chunk of the higher motor vehicle fatality rate in Florida that Matt cites. Ceteris paribus, old people are bad drivers and die more easily in crashes. Also golf carts don’t typically come with roll cages.
Your bias is showing, desantis coverage has been far more positive than it warrants with all kinds of glowing "winning the pandemic" coverage from politico etc.
I noted at the time of Walensky's no masks for the vaccinated announcement how disheartening it was to see so many public health media types urging the CDC to prevaricate on this. Matt is right that staying in their actual lane of expertise is the best way for experts to serve the public, but it is fundamentally contrary to human nature. People like to opine, as we can all personally attest.
I have nothing to add to this.
Adjusting for age, Florida did better than California. Yes, Florida had 8% more deaths per capita than California, but it has 42% more seniors per capita (20% versus 14% of the population). COVID was not an equal opportunity killer, 79% of deaths were among seniors. That means, other things constant, Florida’s death rate would have been 23% or 24% higher than California’s.
The difference likely flows from California real estate being too expensive, which means more multigenerational households. Workers who could not afford to quarantine were especially likely to live with parents or grandparents. In other words, the zoning and housing scarcity that MY hates more than nullified the effects of months of coercive distancing.
The more intriguing question is why Florida did better than Texas and the answer is likely Florida did a better job of protecting nursing homes, where targeted interventions can save lots of lives.
You hit the nail on the head. The winter outbreak in SoCal appears to have been largely "essential" workers getting sick at work and coming home to overcrowded often multi generational households. Unsafe working conditions + Housing scarcity.
Random thoughts on other possible explanations . . .
If you accept MY's theory that it is more about people's individual choices to apply those policies to themselves, then it makes sense that more-conservative Texas would do a little worse than less-conservative (though still conservative) Florida.
There is also the weather difference between FL and CA. There are very few days in FL where people need to be inside to stay warm. That isn't true of most of CA.
Covid doesn’t care whether you are in doors for air conditioning or for heat. It’s more pleasant to be outdoors in coastal california during the summer than florida
Fair point.
FL didn’t really get awful Summer heat until a few days ago, so in a crucial time to keep people outdoors, FL’s weather was really helpful this Winter.
Summer happened in 2020 also.
What definition of conservative are you using here? The easiest one for me to call to mind is political party preference and FL was 3% for Trump while Texas was 5%. That's only "more conservative" by 1 out of 100 people switching their vote.
Also as David said - being indoors using the AC might be just as bad for sharing air and aerosols. The summer 2020 wave of covid actually tracked "AC season" fairly closely, starting in Arizona in Late May / Early June then shifting north about a state pre month
>>>Adjusting for age, Florida did better than California.<<<
***Adjusting for age, Florida HAS DONE better than California***
Fixed. Seriously, covid is still claiming a couple of thousand Americans weekly. It remains to be seen where the states will rank this time next year.
Among people who say "a return to normalcy," how many are really calling for a return to normal and how many are making an esoteric joke about Warren G. Harding?
I think it's all the former because the phrase is so ingrained in everyone's use of English now, but I, for one, would appreciate a return to 'normality'
"Normalcy" has been around since the 19th century. It predates Harding by decades.
I know. I still don't like it. We don't say 'formalcy', 'abnormalcy', 'animalcy'; there's no parallelism.
Weird that you're so pissed off, tho. What causes this animosicy? Why so much hostilicy? What's the utilicy in resisting realicy?
On second thought, I guess the parallel abominations should be "realcy", "hostilcy" and "utilcy". And I suppose "animoscy," but that's too much of a monstroscy.
I was going to make this correction.
I forget if you read Noahpinion also, but seeing these spellings reminded me of his younger "ascerbic" self that he mentioned today.
Isn't the parallel is "lunacy"? Or is the search for a parallel lunacy?
Not mutually exclusive!
"The people who feel so confident that they could have threaded a perfect bank-shot of mask/vaccine rhetoric to keep the mandates in place longer if they were in Walensky’s shoes aren’t seeing the whole field."
That's not so much a mixed metaphor as it is the product of tossing sewing, billiards, ladies' footwear, and football into a Cuisinart and hitting puree.
I gave you a like for this, but I thought your Cuisinart/puree image was disappointingly coherent.
Didn't you mean to say that he mainlined a Category 5 dumpster fire into a Cuisinart, and turned it up to 11?
Matthew was just trying to keep the playing field on the straight and narrow.
I really appreciated this piece.
The other day a man drove past me on a dirt bike, popping a wheelie down a residential street at dusk, helmetless - but wearing a surgical mask, which he carefully adjusted with one hand after landing his front wheel on the road.
It was funny, but reminded me yet again that normal people just plain suck at any sort of risk assessment. If you are reading through multiple articles to try to figure out how to model the relative risk of various behaviors so you can understand the tradeoffs, then you are a weirdo. As am I.
It's frustrating watching the public health establishment implicitly accept that people suck at this to some degree, but then conclude that that's why they need to manipulate everyone - because they just won't "get it" otherwise. The opposite conclusion is more reasonable: people suck at this, so we should try to make all of our communications simple, clear, fact based, and as far as possible, intuitive. ("People breath the virus out, so if you're gonna spend time inside, open a couple windows" is not something you need a complicated risk assessment to understand) The CDC's communication is far from perfect now, but it's vastly improved since the Trump administration ended.
I was on a shuttle heading to a wedding last weekend for a very progressive and liberal friend of mine who has a very liberal and progressive social circle. I noticed everyone had masks on (and were vaccinated) but I was the only one wearing my seatbelt as we drove down the freeway. Later that night they passed around and drank from a bottle of whiskey and somebody said "hey we're all vaccinated". I thought "yeah, from covid, but not from lots of other diseases". Still drank the whiskey of course of I'm not a complete buzzkill
Maybe the guy on the dirt bike was a risk taker with his own safety. but concerned about yours.
One issue with that is you can't say "open some windows" without data confirming that will actually work. And since we can't throw random people in a room with someone sick and see what happens and then try it again with a new group and an open window, you're kind of stuck.
Not a dig at you personally, but this kind of thinking drives me crazy. Are we really institutionally unable to reason under uncertainty?
If I kidnapped 100 epidemiologists and lock them in individual rooms with COVID positive patients and a single window, would any of them not open the window and stand next to it?
Life doesn't wait for perfect info for perfect communications. We have to do the best we can with what we have. In April of 2020, that would have meant telling people to open a window if they insisted on being inside with others outside their households.
And if you're honest about the limitations of your data, and why you're making the best recommendation that you can, people are more likely to listen when you update based on new data. If they sense that you're BS'ing them from the start, they're going to suspect that you're still BS'ing them when you change the guidance.
In the kidnapping scenario, the epidemiologists have no cost to opening the window - if it's efficacy isn't negative, they might as well. It might be hygiene theater but there's no cost to them for doing it.
On one hand, reasoning under uncertainty is necessary. But if we have _no_ real data, I think guessing is counter-productive. So I don't need double-blind trials for the open window theory but some evidence other than "epidemiologists would do it if they had no other options" is needed to reason under uncertainty.
It seems like common sense that opening windows increases ventilation and airflow. By how much exactly I don't know. But there are plenty of studies on air circulation so data for making inferences is out there.
My common sense says that if I have 10 people in my dinning room and I open the window on a calm day, the little bit of breeze would somewhat decrease the concentration of viral particles. But not by much.
Picture you're at a dinner party with 10 people in your dining room and a few of them are smoking. Would opening the windows make a little bit of difference in lowering the smoke in the air or a lot?
I was thinking about a Smokey kitchen as an example. It helps a little. But if they or the stove are still smoking it’s still going to be pretty Smokey. Now if you’re saying put a box fan in one of the windows? That would make a huge difference. Especially with some cross ventilation. But that’s a lot more than just open a window.
>>>And note that Abbott, like most Republican governors, has been promoting vaccination.<<<
When he's not actively interfering with the efforts of the private sector to require vaccinations, sure!
https://www.nbcdfw.com/news/local/texas-news/gov-greg-abbott-signs-bill-prohibiting-texas-business-from-requiring-proof-of-covid-19-vaccine/2651902/
(Public health is important, except when it conflicts with the need to court your party's wingnut base).
I have noticed that a lot of people I know are very upset about the CDC rolling back mask requirements and the reason is usually that it freaks them out because it seems unsafe to them. And they’re the type who’ve spent the last year saying the believe in a science. They also spent early 2021 consuming news from sources that insisted we had no idea if the vaccines prevented infections so they also had to get used to the idea that being vaccinated means you almost certainly can’t infect others.
Some of that could have been mitigated if the CDC had done a better job of communicating risk throughout the pandemic.
Or if the CDC had *ever* done a better job of communicating risk. They seem to speak a language entirely of "do"s and "don't"s, with no "A is riskier than B is riskier than C, and you can use this information together with your priorities to determine which things you should and shouldn't do".
Also, I always want to rant about how carcinogens are classified - by strength of *evidence* that an association exists with cancer, and *not* by degree of risk increase:
"The lists describe the level of evidence that something can cause cancer, not how likely it is that something will cause cancer in any person (or how much it might raise your risk). For example, IARC considers there to be strong evidence that both tobacco smoking and eating processed meat can cause cancer, so both are listed as “carcinogenic to humans.” But smoking is much more likely to cause cancer than eating processed meat, even though both are in the same category."
https://www.cancer.org/cancer/cancer-causes/general-info/known-and-probable-human-carcinogens.html
Also everything in the state of California causes cancer but fortunately they label it so that residents can avoid it all.
Does that also explain why everything in the state of California is always on fire?
This is all well and good, but seriously what's up with those differences in motor vehicle fatality rates? This table has both the deaths per 100,000 residents, but also per 100 million vehicle miles traveled: https://www.iihs.org/topics/fatality-statistics/detail/state-by-state
By the latter, South Carolina does the worst followed by Mississippi and then New Mexico, but there are a lot clustered around there at 1.4 or 1.5. There's some really good charts here on seatbelt use, alcohol involvement, and types of crashes.
My understanding is that biggest factor in fatal crashes is speed. It make sense that rural areas would have higher fatality numbers because of their speed limits are higher than urban areas. I would be interested to see data on how states implement speed limits to see if that was a major difference in these rankings.
It's not just speed limits: it's just harder to get high speeds in urban environments: frequent stop lights, more traffic, narrower roads, etc. The environment around you even makes the perception of how fast you're going different.
In Miami there doesn’t seem to be a speed limit other than horsepower.
It's also vehicle type. Newer and more expensive vehicles have better safety performance. Rural areas also skew towards trucks - often heavier - which increased impact intensity.
You have to break out safety performance for people inside the vehicle from safety performance for people hit by the vehicle from safety performance for people in another vehicle hit by the vehicle.
This probably makes a huge difference in the state-by-state comparisons: https://www.iihs.org/topics/fatality-statistics/detail/urban-rural-comparison
"In 2019, the rate of crash deaths per 100 million miles traveled was about 2 times as high in rural areas as in urban areas (1.66 in rural areas compared with 0.86 in urban areas)."
It's just safer to drive in urban areas: speeds tend to be slower, which dramatically lowers crash risk and crash severity when crashes occur.
It's also distance to the nearest hospital. The survival rate for a given severity of accident is dramatically higher if you're in the ER within one hour.
I don't know if this is still the case, but at least fairly recently it was legal to drive a moped in SC without a drivers license. And so if someone lost his license due to a drunk driving conviction, he'd just get a moped for the duration. I'm not suggesting that is the cause of their dismal rank, just an indication of the culture. I think it's also the case that they either do not require vehicle inspections, or are very lax about it.
Matt should do a Weeds on this. There's definitely researchers out there who have done some pretty in-depth research.
So… I just looked.
Race downs have much impact on motor vehicle fatality rates with the exception of American Indians. I confess, I expected higher Hispanic rate, but was wrong.
Poverty has very little effect on motor vehicle fatality rates.
Being Southern does have a big effect (whether white or black).
So does living in rural areas.
https://pubmed.ncbi.nlm.nih.gov/30172108/
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/810995
Texas and Louisiana have drive through cocktails, which always struck me as kind of incredible. Not really a California thing, at least not pre-pandemic.
Does southernness correlate with lax DUI laws and enforcement?
It's really weird to me that Texas combines drive through cocktails with no liquor purchases on Sundays. It's a weird mix of lax and strict.
They are trying to discourage driving on Sundays.
I’m am pretty sure that poverty factors into it.
Idaho didn’t do as bad as I expected even though we have an extremely young driving age (15-years old).
Without disaggregated numbers we can only guess.
See above. My suspicion that poverty factors into it was wrong. Being southern and living in a rural area does.
That is interesting!
Yes. I thought so. I love when I’m wrong. Keeps me on my toes.
Interesting. You might have expected states with more inclement weather to do worse.
As others have pointed out with respect to Covid deaths in another thread, Florida and some other states have a higher portion of very elderly people, who are perhaps more likely to crash.
As interesting is that America doesn't do great on deaths relative to vehicle miles travelled compared to (most) European nations.
There are a few reasons why this might be, one factor is that America has more remote areas where someone involved in an accident will take longer to get help and get to a hospital.
Can we talk about our current airline/airport regulations? I was on a flight a couple of weeks ago which started out with very stern PA messages about mask wearing. And then I spent the rest of the flight with my mask mostly down because the very attentive flight attendant kept bringing me drinks and snacks. For the record I’m fully vaccinated so I’m confident I didn’t put anyone in danger, but I don’t think this is helping our society regain trust in public health messaging.
I've been on several flights in the past month, and my experience was the exact opposite. The flight attendants were very stern about the masks being up and worn properly, even in between sips and bites. It actually struck me as a bit too much, and I was a proper mask wearing fanatic prior to vaccination.
I think we were sunk on a lot of this already last year when the CDC said "masks on inside any time you're not eating" as opposed to "masks on inside, and avoid things you can't do without removing the mask".
The thing is, it's probably fine; not everything you do with your nose and mouth generates the same level of aerosols. If you're sitting there breathing normally (that is to say, fairly shallowly because you're inactive) you probably don't generate too many. If you talk or sing or shout or work out, that's when it's most necessary to have a mask.
I think this is probably right, so for air travel shouldn’t we say the same thing we say to grocery store shoppers: masks are optional for fully vaccinated people?
Probably, but it took them ten years to say that Bluetooth headphones were safe.